Successful use of balloon tamponade in the management of postpartum hemorrhage in a case of bicornuate uterus

Worldwide 50%–70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed by massive postpartum hemorrhage managed successfully with balloon tamponade. The use of uterine balloon tamponade as an effective method to control postpartum hemorrhage has been studied extensively, but use in cases of hemorrhage associated with uterine malformations has not been reported much in literature. Use of uterine balloon tamponade in case of uterine malformations has been highlighted in our case as an effective non-surgical method to control hemorrhage

Students’ perspective for online teaching program “Survive” during period of Covid-19.

Introduction: During panacea of Covid-19; educational institutes started online teaching program. This was first experience for almost all faculty members and the students. As we all are familiar with face-to-face learning; it is imperative to get feedback from the students regarding their experience of online academic activities. Objective: To document the students’ perspective regarding online teaching program of Muhammad Medical College Mirpurkhas named as “SURVIVE” Methodology: After approval from Research and Ethical Committee of Muhammad Medical College this questionnaire-based study conducted during month of July 2020. This self-constructed questionnaire has 6 components: Organization and Structure, Teaching and learning, Teaching staff and other students, Assessment, Attribute development and Unit performance as a whole. Each component had 3-4 questions and students had to rate their satisfaction level on Likert scale. Results: Each component of the questionnaire was examined. Among participants; female students (n=103) outnumber male students (n=22). The highest number of students were from 4th year MBBS (n= 47; 37.6%) followed by 1st year BDS (n=26;20.8%) and final year MBBS (n=25; 20%). Overall, 106 (86%) students rated Survive as satisfactory. Conclusion: Being first experience, yet survive was found nearly in all aspect as satisfactory way of leaning during pandemic of Covid-19

Konstruktiv dimensjonering av betongdekker med fokus på reduksjon av klimagassutslipp

Global oppvarming er en av de største utfordringene samfunnet vårt står overfor, og det har aldri vært viktigere å innføre tiltak som vil redusere utslippet av klimagasser. Byggenæringen, og spesielt sementindustrien, er ansvarlig for en stor andel av klimagassutslippene globalt. For å gjøre byggenæringen mer miljøvennlig er det viktig å fokusere på tiltak som vil redusere utslippet av CO2, som er en av klimagassene som bidrar mest til global oppvarming. Dekker er et av de viktigste bæreelementene i en konstruksjon og utgjør en stor andel av det totale betongvolumet. Dimensjonering av dekker med fokus på redusert sementbruk vil dermed ha stort potensial for å redusere klimagassutslippet til en betongkonstruksjon. I denne oppgaven er det derfor valgt å undersøke i hvilken grad konstruktive valg av dekker påvirker klimagassutslippet til en konstruksjon. Det er valgt å undersøke tre ulike slakkarmerte dekker: bjelke/plate-dekke (toveisdekke), flatdekke og BubbleDeck. En enkel konstruksjon med to ulike spennvidder og varierende dekketykkelser modelleres som utgangspunkt for problemstillingen og det er tenkt at modellbygget skal representere et kontor. Det vil utarbeides et klimaregnskap for å finne klimagassutslippene til dekkene som skal måles i CO2-ekvivalenter, basert på utslippsverdier fra Norsk Betongforening sin publikasjon nr. 37 og EPDer fra EPD Norge. Resultatene fra klimaregnskapet viser at det er stort potensial for å redusere utslippet av CO2 ved å velge dekker med redusert betongvolum. Både flatdekke og BubbleDeck som er to typer dekker som ligger direkte på søyler, har et mye lavere klimagassutslipp enn et tradisjonelt bjelke/plate-dekke. BubbleDeck skiller seg spesielt ut ved at det har omtrent en tredjedel mindre betongvolum enn et tilsvarende flatdekke på grunn av plastboblene som erstatter den delen av betongen som ikke har en strukturell funksjon. Grunnet den lave egenvekten til dekket, vil BubbleDeck også ha den fordelen at andre konstruksjonselementer kan dimensjoneres mindre, som vil være positivt for hele konstruksjonens klimaregnskap. Felles for både flatdekke og BubbleDeck er at små spennvidder og mindre dekketykkelser gir et lavere utslipp framfor lengre spenn og tykkere dekker. Videre viser resultatene at det kan være en ytterligere miljøgevinst ved å benytte seg av lavkarbonbetong og velge riktig fasthetsklasse. Resultatene fra masteroppgaven viser at det er stort potensial for å redusere klimagassutslippet til betongkonstruksjoner ved å fokusere på å dimensjonere dekker som krever mindre betong i prosjekteringsfasen. Spennvidde, dekketykkelse, betongtype og fasthetsklasse vil være viktige faktorer som vil kunne ha en påvirkning på klimagassutslippet.Global warming is one of the biggest challenges facing our society, and it has never been more important to introduce measures to reduce greenhouse gas emissions. The construction industry, and especially the cement industry, is responsible for a large proportion of global greenhouse gas emissions. To make the construction industry more environmentally friendly, it is important to focus on measures that will reduce the emission of CO2, which is one of the greenhouse gases that contributes the most to global warming. Slabs are one of the most important load-bearing elements in construction, making up a large proportion of the total concrete volume. Dimensioning slabs with a focus on reduced cement use will thus have great potential for reducing the greenhouse gas emissions of a concrete structure. In this thesis, it has therefore been chosen to examine the extent to which constructive choices of concrete slabs affect the greenhouse gas emissions of a construction. It has been chosen to study three different slabs: conventional slab, flat slab, and BubbleDeck. A simple construction with two different spans and varying slab thicknesses is modeled as a starting point for the problem and it is intended that the model building should represent an office. Calculations will be carried out to find the greenhouse gas emissions of the slabs to be measured in CO2 equivalents, based on emission values from the Norwegian Concrete Association's publication no. 37 and EPDs from EPD Norway. The greenhouse gas calculations results show great potential for reducing the emission of CO2 by choosing slabs with a reduced concrete volume. Both flat slab and BubbleDeck, which are two types of slabs that lie directly on columns, have much lower greenhouse gas emissions than a conventional slab. BubbleDeck stands out in that it has about a third less concrete volume than a similar flat slab, due to the plastic bubbles that replace the part of the concrete that does not have a structural function. Due to the low specific weight of the slab, BubbleDeck will also have the advantage that other construction elements can be dimensioned smaller, which will be positive for the entire construction climate accounting. Both flat slabs and BubbleDeck have in common that small spans and smaller slab thicknesses result in lower emissions than longer spans and thicker slabs. Furthermore, the results show that there can be a further environmental benefit by using low-carbon concrete and choosing the right strength class. The results from the master's thesis show that there is great potential to reduce the greenhouse gas emissions of concrete structures by focusing on dimensioning slabs that require less concrete in the design phase. Span width, cover thickness, concrete type, and strength class will be important factors that could have an impact on greenhouse gas emissions

Mechanisms of p53-induced mitochondrial biogenesis in skeletal muscle

p53 is a pleiotropic protein that is mutated in many types of cancers. It is involved in regulating various distinct cellular pathways including apoptosis, cell cycle arrest, senescence, autophagy, angiogenesis, and most relevant to this dissertation, cellular metabolism. While extensive research has been conducted on p53 in cancer biology, the role of this protein in modulating mitochondrial function in skeletal muscle has only been recently investigated. Thus the aim of this dissertation was to assess the mechanisms by which p53 induces and controls aerobic metabolism in skeletal muscle, and the subsequent impact it carries on exercise-mediated pathways that elicit an increase in mitochondrial bioenergetic capacity. First, we examined the effect of p53 on mitochondrial protein import and complex IV assembly. Using subsarcolemmal (SS) and intermyofibrillar (IMF) mitochondria isolated from p53 wildtype (WT) and knockout (KO) mice, we discerned no effects of p53 on the rate of protein import. However, the expression of several proteins involved in the import process was reduced in the KO mice. Assembly of complex IV was impaired in the IMF mitochondria, along with the assembly co-factor Surf1, which may facilitate the previously documented attenuation of mitochondrial function in the p53 KO mice. Next we evaluated whether p53 is recruited in response to endurance exercise. To assess this, we subjected C57B1/6 mice to an acute run at 15m/min for 90 minutes ± 3 hours recovery, and subsequently measured alterations in content, and sub-cellular localization of p53. The nuclear p53 content decreased steadily with acute exercise and post-recovery, in sharp contrast to the increase in p53 abundance in SS and IMF mitochondria. Concomitantly, higher levels of mitochondrial p53 were complexed with Tfam, the mitochondrial DNA (mtDNA) transcription factor, and with mtDNA at the D-loop with exercise and recovery. We identified putative p53 response elements in the D-loop, and hypothesized that p53 could be mediating mtDNA transcription in collaboration with Tfam. Further support for this was derived from the observation that the exercise-induced increase in mtDNA-transcribed protein COX-I was completely abrogated in p53 KO mice. Lastly, we sought to determine the necessity of p53 to the exercise-induced changes that transpire within the muscle upon an imposed metabolic and physiological challenge such as a bout of endurance exercise. p38 MAPK activation was abolished, whereas AMPK and CaMKII signalling was attenuated with exercise in p53 KO mice. This occurred in tandem with lower levels of PGC-1? translocation into the nucleus, and subsequently attenuated the increase in mRNA content of genes involved in mitochondrial biogenesis. While non-exercised p53 KO mice displayed an impaired ability to undergo autophagy during basal conditions, there was no difference in the activation of autophagic proteins post-exercise in p53 KO vs. WT mice. Collectively, our data illustrate that p53 is integral to maintaining baseline levels of mitochondrial content and function, and is intimately involved in, and necessary for the signaling process initiated upon acute endurance exercise that mediates mitochondrial biogenesis

Paediatric pseudo papillary pancreatic tumour: A case based review

Solid pseudopapillary neoplasms are rare and represent approximately 4% of all cystic pancreatic tumours, and predominately affect females. They have an excellent prognosis, however 10-15% of the patients show metastasis at the time of surgery or recurrence of tumour during follow-up after pancreatectomy. Surgical resection is the recommended treatment. We present a rare case of a 15-year-old female, with a pseudopapillary tumour of the pancreas which was diagnosed pre-operatively

Successful completion of pregnancy after mustard procedure for transposition of great arteries: A rare case from the developing world

Surgical repair of transposition of great arteries has undergone various evolutionary changes over the years. The initial of these treatment options was atrial septectomy followed by atrial switch and the current preferred treatment option is arterial switch operation worldwide. Due to various reasons, like lack of medical and surgical expertise atrial switch operation was commonly in practice in developing countries until few years back. Pregnancy in a patient with history of atrial switch operation poses a unique haemodynamic challenge. We report the case of a successful pregnancy in a 26 years old lady who had undergone Mustard repair surgery in the past in Pakistan