Comparative study of efficacy and safety of vaginal misoprostol versus oral misoprostol in induction of labour when used in equal doses

Background: It was a randomized controlled prospective study. A large number of women in their advanced pregnancies often need labour induction for various reasons. This study aims to evaluate a safe, effective and inexpensive mode of medical induction. The purpose of the study is to evaluate the safety and efficacy of vaginal misoprostol versus oral misoprostol in induction of labour when used in equal doses.Methods: Two hundred patients were included in the study. They were divided into two groups of 100 patients each. One group i.e. Group A received vaginal misoprostol while the other group i.e. Group B received oral misoprostol. The dosage was 50μg every 6th hourly maximum of four doses. The progress of labour in both groups was charted on a partogram. The outcome of pregnancy, maternal and foetal outcomes were statistically analysed.Results: When compared with respect to age, height, gestational age, indication for induction, there was no difference in either of the groups. The numbers of doses of misoprostol for successful outcome of labour in the vaginal group i.e. 2.25±0.53 was lesser than the dosage needed in the oral group i.e. 2.71±0.60 (P value M 0.0001). which is highly significant. The induction-delivery interval was also less in the vaginal group compared to the oral group. (12.90±2.40 hours versus 15±75 hours). Only 13 women in the vaginal group needed acceleration with oxytocin in contrast to 17 women in the oral group. The need for caesarean section in women induced with vaginal misoprostol was 12 women in comparison to oral group which was 32 women. No statistically significant difference was seen in neonatal outcome in either of the groups.Conclusions: When given in equal doses the vaginal administration of misoprostol is more effective in successful induction of labour when compared to oral misoprostol

Pregnancy outcome in low risk pregnancy with decreased amniotic fluid index

Background: To evaluate whether oligohydramnios (AFI≤5) has any significance in the outcome of low risk pregnancies. Normal amniotic fluid index in pregnancy is one of the indicators of fetal well-being.  In a term pregnancy, oligohydramnios, a condition associated with AFI≤5, could be a sign of placental insufficiency. An association of low AFI with complications like pregnancy induced hypertension, consistently leads to poor fetal outcome. A need to deliver the fetus by cesarean section often arises. Occasionally one comes across a full-term pregnancy with AFI ≤5 with no known high risk factors; this could lead to increased cesarean section rates. Thus, it becomes necessary to evaluate if AFI ≤5 in the absence of other risk factors has any significance on obstetric outcome.Methods: Prospective case controlled study was done. Fifty women with term pregnancies and (AFI≤5) cm not associated with any other high risk factors were enrolled for the study. They were matched with fifty controls with normal AFI.Results: Except for a slight increase in variable deceleration in the study group, no differences were noted with fetal heart rate recordings in NST.  Decreased AFI was not associated with increased cesarean section rates, instrumental deliveries or meconium stained amniotic fluid. Severe asphyxia, NICU admission or perinatal mortality was not noted in either group.Conclusions: When a low risk pregnancy is associated with Oligohydramnios (AFI≤5), it does not have any deleterious effect on labor outcome or perinatal outcome

Chemical composition of UV-bright star ZNG 4 in the globular cluster M13

We present a detailed model-atmosphere analysis of ZNG 4, a UV-bright star in the globular cluster M13. From the analysis of a high resolution ($R \approx 45,000$) spectrum of the object, we derive the atmospheric parameters to be $\rm T_{eff} = 8500\pm 250$ K, log g $=$ 2.5 $\pm$ 0.5 and $\rm [Fe/H]= -1.5$. Except for magnesium, chromium and strontium, all other even Z elements are enhanced with titanium and calcium being overabundant by a factor of 0.8 dex. Sodium is enhanced by a factor of 0.2 dex. The luminosity of ZNG 4 and its position in the color-magnitude diagram of the cluster indicate that it is a Supra Horizontal Branch (SHB) (post-HB) star. The underabundance of He and overabundances of Ca, Ti, Sc and Ba in the photosphere of ZNG 4 indicate that diffusion and radiative levitation of elements may be in operation in M 13 post-HB stars even at $\rm T_{eff}$ of 8500K. Detailed and more accurate abundance analysis of post-HB stars in several globular clusters is needed to further understand their abundance anomalies.Comment: 17 pages, 5 figures, Accepted for publication in A&

General mechanism for amplitude death in coupled systems

We introduce a general mechanism for amplitude death in coupled synchronizable dynamical systems. It is known that when two systems are coupled directly, they can synchronize under suitable conditions. When an indirect feedback coupling through an environment or an external system is introduced in them, it is found to induce a tendency for anti-synchronization. We show that, for sufficient strengths, these two competing effects can lead to amplitude death. We provide a general stability analysis that gives the threshold values for onset of amplitude death. We study in detail the nature of the transition to death in several specific cases and find that the transitions can be of two types - continuous and discontinuous. By choosing a variety of dynamics for example, periodic, chaotic, hyper chaotic, and time-delay systems, we illustrate that this mechanism is quite general and works for different types of direct coupling, such as diffusive, replacement, and synaptic couplings and for different damped dynamics of the environment.Comment: 12 pages, 17 figure

Bubbling and bistability in two parameter discrete systems

We present a graphical analysis of the mechanisms underlying the occurrences of bubbling sequences and bistability regions in the bifurcation scenario of a special class of one dimensional two parameter maps. The main result of the analysis is that whether it is bubbling or bistability is decided by the sign of the third derivative at the inflection point of the map function.Comment: LaTeX v2.09, 14 pages with 4 PNG figure

Dietary iron intake in the first 4 months of infancy and the development of type 1 diabetes: a pilot study

<p>Abstract</p> <p>Aims</p> <p>To investigate the impact of iron intake on the development of type 1 diabetes (T1DM).</p> <p>Methods</p> <p>Case-control study with self-administered questionnaire among families of children with T1DM who were less than 10 years old at the time of the survey and developed diabetes between age 1 and 6 years. Data on the types of infant feeding in the first 4 months of life was collected from parents of children with T1DM (n = 128) and controls (n = 67) <10 years old. Because some cases had sibling controls, we used conditional logistic regression models to analyze the data in two ways. First we performed a case-control analysis of all 128 cases and 67 controls. Next, we performed a case-control analysis restricted to cases (n = 59) that had a sibling without diabetes (n = 59). Total iron intake was modeled as one standard deviation (SD) increase in iron intake. The SD for iron intake was 540 mg in the total sample and 539 mg in the restricted sample as defined above.</p> <p>Results</p> <p>The median (min, max) total iron intake in the first 4 months of life was 1159 (50, 2399) mg in T1DM cases and 466 (50, 1224) mg among controls (<it>P </it>< 0.001). For each one standard deviation increase in iron intake, the odds ratio (95% confidence interval) for type 1 diabetes was 2.01 (1.183, 3.41) among all participants (128 cases and 67 controls) while it was 2.26 (1.27, 4.03) in a restricted sample of T1 D cases with a control sibling (59 cases and 59 controls) in models adjusted for birth weight, age at the time of the survey, and birth order.</p> <p>Conclusion</p> <p>In this pilot study, high iron intake in the first 4 months of infancy is associated with T1DM. Whether iron intake is causal or a marker of another risk factor warrants further investigation.</p