Comparative study of mifepristone plus vaginal misoprostol Versus vaginal misoprostol alone for second trimester abortion

INTRODUCTION: Mid trimester termination of pregnancy is one of the controversial issues in obstetrics and gynecology which has moral, technical, emotional and social issues. Many Indian women opt for MTP (Medical Termination of Pregnancy) in second trimester inspite of increased morbidity like excessive hemorrhage, uterine perforation and infection because of unplanned pregnancies. In addition, there is a continuous need for termination of pregnancy in second trimester as there are advanced antenatal diagnostic tests which enable us to identify lethal fetal anomalies. Termination of pregnancy in second trimester is associated with much more morbidity and mortality than when it is done in the first trimester. The various methods for second trimester termination of pregnancy are still under scrutiny and the search for the ideal method which is the safest, easiest, cheapest and optimally most effective is still going on. Second trimester pregnancy termination can be carried out by both medical and surgical methods. Medical methods are comparatively safer and have superseded the surgical methods because of risks involved in surgical methods. AIMS AND OBJECTIVES: 1. To compare the abortifacient efficacy of vaginal misoprostol with mifepristone and vaginal misoprostol alone in second trimester pregnancy termination. 2. To compare the induction -abortion intervals. 3. To compare side effects and complications. 4. To compare the Cost effectiveness. 5. To identify the suitable method for second trimester MTP by comparing the various parameters. MATERIALS AND METHODS: This study comparing the efficacy of mifepristone – vaginal misoprostol combination with vaginal misoprostol alone as a method of second trimester abortion conduct at Institute of obstetrics and Gynaecology, Chennai – 08 during October 2009 – October 2010. Study design: Prospective randomized comparative study. Study Place : Institute of obstetrics and Gynaecology, Chennai-8. Collaborating Unit : Department of family welfare, IOG. Study Population : Patients requesting abortion in their second trimester at Department of family welfare, IOG and patients requiring abortion at second trimester at IOG, Egmore. Period of Study : OCT2009 – OCT2010. Sample Size: 100 (Randam allocation to either group), 50 – mifepristone + vaginal misoprostol group, 50 – vaginal misoprostol group. Inclusion Criteria: 14 – 20 weeks gestation, Woman full filling the MTP indicators as per the MTP act ,Single live fetus, Present with closed cervical os, No vaginal bleeding and Patients consenting to this procedure only. Exclusion Criteria : History of previous uterine surgery (but not a contraindication), Known allergy / Contraindications to mifepristone (or misoprostol / prostaglandin), Multiple fetus, Intra uterine fetal demise, Presentation in active labour, Low lying placenta. SUMMARY: 1. One hundred Patients opting for second trimester pregnancy termination or diagnosed to have anomalous fetus were considered for the study. Fifty patients received 200mg Mifepristone ,followed by 800mcg vaginal misoprostol 36 hours later, followed by 400mcg vaginal misoprostol every 3 hours interval of maximum 4 doses or until delivery. In another fifty women, 800mcg vaginal misoprostol followed by 400 mcg vaginal misoprostol every 3 hrs interval of maximum 4 doses or until delivery. 2. The two groups were comparable with respect to maternal age, parity and gestational age at the time of induction of abortion. Majority of patients in either group were in the age group of 21- 25 years. The commonest gestational age in both group was between 17-18 weeks. 3. There were more multigravida than primigravida in both the groups. Induction abortion interval in primigravida is more compared to multigravida in both group and it was statistically significant in Mifepristone and misoprostol combination (pvalue.01). 4. The most common indication for pregnancy termination in both group was unwanted pregnancy due to social reasons. 5. Induction abortion interval in Mifepristone and misporstol group was 8.2 hours and that in misoprostol alone group was 12.8 hours.The difference between them was found to be statistically significant (p value 0.000). 6. According to the gestational age, induction abortion interval was not statistically significant in both groups. 7. The percentage of complete abortion in Mifepristone and misoporostol group was 90% and in misoprostol group was 72% but the difference was not statistically significant. The percentage of incomplete abortion was 10% in Mifepristone and misoprostol group and was 24% in misoprostol alone group which did not reach statistical significance. 8. There was no failure in Mifepristone and misoprostol group and 4% in misoprostol alone group, but it was not statistically significant. The complete abortion rate within 12 hours was 76% in Mifepristone and misoprostol group and 36% in misoprostol alone group and in 24 hrs it was 100% and 96% respectively. Additional intervention needed in Mifepristone and misoprostol combination group was 10% and in misoprostol alone group was 28%and most common being instrumental evacuation. 9. The mean dose of misoprostol used was 1376 mcg and that of misoprostol group was 1992 mcg. 10. The average cost in misoprostol alone group was rupees 194.2 and Mifepristone and Misoprostol combination group was rupees 483.1, which is two times higher. 11. There was no statistically significant side effects between two groups and no major maternal complications found in both group. 12. It was observed that no bleeding (or) abdominal pain (or) any adverse reactions were not reported after administration of Mifepristone prior to vaginal Misoprostol administration (36 hrs). so Mifepristone could be administered safely prior to hospital admission for termination. CONCLUSION: Comparing Mifepristone and Vaginal misoprostol combination with vaginal misoprostol alone for second trimester pregnancy termination, it was observed that, Mifepristone with vaginal misoprostol combination group is associated with shorter induction abortion interval and 100% success rate. The complete abortion rate , success rate and side effects were comparable in both group. Vaginal misoprostol alone group also dosen’t have the 36 hours anxiety/unease from the time of mifepristone administration. Vaginal misoprostol alone group is cost effective. Hence vaginal misoprostol alone group can also be considered as an effective alternative for Mifepristone and vaginal misoprostol combination group

Learning Interpretable Rules for Multi-label Classification

Multi-label classification (MLC) is a supervised learning problem in which, contrary to standard multiclass classification, an instance can be associated with several class labels simultaneously. In this chapter, we advocate a rule-based approach to multi-label classification. Rule learning algorithms are often employed when one is not only interested in accurate predictions, but also requires an interpretable theory that can be understood, analyzed, and qualitatively evaluated by domain experts. Ideally, by revealing patterns and regularities contained in the data, a rule-based theory yields new insights in the application domain. Recently, several authors have started to investigate how rule-based models can be used for modeling multi-label data. Discussing this task in detail, we highlight some of the problems that make rule learning considerably more challenging for MLC than for conventional classification. While mainly focusing on our own previous work, we also provide a short overview of related work in this area.Comment: Preprint version. To appear in: Explainable and Interpretable Models in Computer Vision and Machine Learning. The Springer Series on Challenges in Machine Learning. Springer (2018). See http://www.ke.tu-darmstadt.de/bibtex/publications/show/3077 for further informatio

Spectroscopic Study of Solvent Effects on the Electronic Absorption Spectra of Flavone and 7-Hydroxyflavone in Neat and Binary Solvent Mixtures

The solvatochromic characteristics of flavone and 7-hydroxyflavone were investigated in neat and binary solvent mixtures. The spectral shifts of these solutes were correlated with the Kamlet and Taft parameters (α, β and π*) using linear solvation energy relationships. The multiparametric analysis indicates that both specific hydrogen bond donor ability and non-specific dipolar interactions of the solvents play an important role in absorption maxima of flavone in pure solvents. The hydrogen bond acceptor ability of the solvent was the main parameter affecting the absorption maxima of 7-hydroxyflavone. The simulated absorption spectra using a TD-DFT method were in good agreement with the experimental ones for both flavones. Index of preferential solvation was calculated as a function of solvent composition. Preferential solvation by ethanol was detected in cyclohexane-ethanol and acetonitrile-ethanol mixtures for flavone and in acetonitrile-ethanol mixtures for 7-hydroxyflavone. These results indicate that intermolecular hydrogen bonds between solute and solvent are responsible for the non-linear variation of the solvatochromic shifts on the mole fraction of ethanol in the analyzed binary mixtures

Effect of Polyphenols on Oxidative Stress and Mitochondrial Dysfunction in Neuronal Death and Brain Edema in Cerebral Ischemia

Polyphenols are natural substances with variable phenolic structures and are elevated in vegetables, fruits, grains, bark, roots, tea, and wine. There are over 8000 polyphenolic structures identified in plants, but edible plants contain only several hundred polyphenolic structures. In addition to their well-known antioxidant effects, select polyphenols also have insulin-potentiating, anti-inflammatory, anti-carcinogenic, anti-viral, anti-ulcer, and anti-apoptotic properties. One important consequence of ischemia is neuronal death and oxidative stress plays a key role in neuronal viability. In addition, neuronal death may be initiated by the activation of mitochondria-associated cell death pathways. Another consequence of ischemia that is possibly mediated by oxidative stress and mitochondrial dysfunction is glial swelling, a component of cytotoxic brain edema. The purpose of this article is to review the current literature on the contribution of oxidative stress and mitochondrial dysfunction to neuronal death, cell swelling, and brain edema in ischemia. A review of currently known mechanisms underlying neuronal death and edema/cell swelling will be undertaken and the potential of dietary polyphenols to reduce such neural damage will be critically reviewed

Design of Filtration System for Aerated Sewage Water

The study investigated the potential of sand and activated charcoal filtration systems to enhance water quality for irrigation by treating aerated sewage effluent from. Setup involved a 60 cm deep sand filter connected as the inlet to another 30 cm deep sand filter and this filter linked as the inlet to a 30 cm deep charcoal filter. These filters were operated in series at hydraulic loading rates (HLR) of 60 m/h and 10 m/h. Notably, operating the filters in series at an HLR of 10 m/h yielded superior effluent water quality compared to an HLR of 60 m/h. System achieved significant removal efficiencies for turbidity, BOD5, COD, Total Nitrogen (Total-N), Total Phosphorous (Total-P) with 71.9%, 54.4%, 71.9%, 44.4%, 39.1%, and 42.9% with a 90 cm deep sand filter at an HLR of 10 m/h, and also with a combination of sand and charcoal filters at an HLR of 25 m/h system achieved 81.6%, 80.3%, 63.5%, 47.5%, and 64.3% respectively. We also examined the chemical characteristics of both untreated and treated sewage water samples, revealing a hierarchy of cation and anion prevalence as follows: Na+ > Ca2+ > Mg2+ > K+ for cations, and Cl- > HCO3- > SO42- > CO32- for anions. Our study demonstrates that the combination of aeration and sand filtration effectively ensures safety by preventing water body pollution and unpleasant odours with high-quality treated wastewater suitable for sustainable agricultural use

Ochronosis

Ochronosis is a rare disorder, which presents with distinct clinical and biochemical features. A fifty seven year old male presented with fracture femur, osteoarthritis, Oslerâ€s sign, alkaptonuria and cutaneous ochronosis. Though the clinical progression of his alkaptonuria was typical, he presented interesting features including non-uniting fracture and arthritis of big and small joints