Maternal near miss: a surrogate indicator of obstetrics care

Background: A maternal near miss (MNM) is an event in which a pregnant woman is on the verge of dying but doesn't die. Despite the fact that most maternal deaths can be avoided, efforts to reduce maternal mortality have not always been successful. This study aimed to identify and analyze the frequency of maternal near-misses (MNMs) cases and causes of maternal near miss due to severe obstetric complications. Methods: A retrospective observational study was carried out at Department of Obstetrics and Gynecology, Heritage Institute of Medical Sciences, Varanasi. The study duration was from January 2021-June 2022. Purposive sampling was used to collect the total of 2053 samples. Results: The study involved in total of 56 maternal near miss cases which includes total of ten maternal deaths. The majority of the respondents have more than 20 years of the age (82.1%) where near miss cases were higher in multiparous women (73.2%). First delays (delay in women seeking help) were almost a third in numbers to affect the maternal mortality and morbidity. Hypertension (32%). hemorrhage (20%) and anemia (14%) were the major leading cause of obstetrical complications. About 66% of the maternal near miss cases needed the interventional management that was ICU admission, mechanical ventilation (41.1%) and blood transfusion (32.1%). Conclusions: Pregnancy hypertension, postpartum hemorrhage, and severe anemia continue to be important determinants of maternal morbidity. First-referral unit facilities and training should be improved so that they can better respond to basic obstetric emergencies such as hypertension, anemia and hemorrhage

Analysis of caesarean section using Robson’s ten group classification in a tertiary care centre

Background: Caesarean section is the most common obstetric operation that saves lives of countless mother and babies. In the past few decades, caesarean section rates have been continuously increasing worldwide. WHO declared that there is no justification for any region to have a caesarean section rate higher than 10-15% and added that CS rates higher than 10% is not associated with reduction in newborn and maternal mortality rates. In 2015, WHO proposed Robson classification as a global standard of assessing, monitoring comparing and auditing the determinants of caesarean sections rates. Methods: This Retrospective study was done in the department of Obstetrics and Gynecology, Heritage institute of medical Sciences, Varanasi. The study duration was from July 2021 to June 2022. Results: A total of 2039 cases underwent delivery during the study duration. The caesarean rate calculated was 46.3%. Group 5 (previous CS, single, cephalic, >37weeks) made the greatest contributor to total CS rate followed by Group 1 (nulliparous, single, cephalic, >37 weeks in spontaneous labor). 100% of women with abnormal lie (group 9) and 87.9% women with breech presentation underwent CS. Conclusions: The overall rate of Caesarean sections is on an increasing trend. Robson’s Group 5 and 1 were the major contributors to caesarean section in this study. RTGCS is a simple useful tool which is a starting point for meaningful analysis of CS both at facility level and across different facilities

Randomized study to compare efficacy of short stretch bandage systems from KOB with locally used Cotton Crepe Bandages in the treatment of lower limb lymphoedema

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Var2CSA Minimal CSA Binding Region Is Located within the N-Terminal Region

Var2CSA, a key molecule linked with pregnancy-associated malaria (PAM), causes sequestration of Plasmodium falciparum infected erythrocytes (PEs) in the placenta by adhesion to chondroitin sulfate A (CSA). Var2CSA possesses a 300 kDa extracellular region composed of six Duffy-binding like (DBL) domains and a cysteine-rich interdomain region (CIDRpam) module. Although initial studies implicated several individual var2CSA DBL domains as important for adhesion of PEs to CSA, new studies revealed that these individual domains lack both the affinity and specificity displayed by the full-length extracellular region. Indeed, recent evidence suggests the presence of a single CSA-binding site formed by a higher-order domain organization rather than several independent binding sites located on the different domains. Here, we search for the minimal binding region within var2CSA that maintains high affinity and specificity for CSA binding, a characteristic feature of the full-length extracellular region. Accordingly, truncated recombinant var2CSA proteins comprising different domain combinations were expressed and their binding characteristics assessed against different sulfated glycosaminoglycans (GAGs). Our results indicate that the smallest region within var2CSA with similar binding properties to those of the full-length var2CSA is DBL1X-3X. We also demonstrate that inhibitory antibodies raised in rabbit against the full-length DBL1X-6ε target principally DBL3X and, to a lesser extent, DBL5ε. Taken together, our results indicate that efforts should focus on the DBL1X-3X region for developing vaccine and therapeutic strategies aimed at combating PAM

Role of imaging modalities in diagnosis of silent caesarean scar ectopic pregnancy after ovulation induction: a case report

There has been an increased prevalence of ectopic pregnancies in the present scenario attributing to 1.5-2% of all pregnancies. Caesarean scar pregnancies are rare, occurring in approximately 1 in 2000 pregnancies, although the incidence is increasing. The increasing rate of caesarean scar ectopic pregnancies mirrors the increasing rate of caesarean delivery. Disruption of the endometrium and myometrium after caesarean delivery predisposes to improper implantation at the site of the prior hysterotomy. Without normal surrounding myometrium, untreated caesarean scar ectopic pregnancies can result in uterine rupture with severe maternal hemorrhage and death. Although ultrasound remains the primary imaging modality for this diagnosis, MRI may be useful in the setting of equivocal cases and also may aid in the detection of possible placental implantation or bladder wall invasion. An MRI may provide additional confirmation of the ultrasound findings and characterize the myometrial interface if the pregnancy is difficult to distinguish from other pregnancy complications such as a cervical ectopic pregnancy or consideration for expectant management of pregnancy is considered

Post V-P shunt surgical site EDH an uncommon complication: A case report

Ventriculoparitoneal shunt is well established modality of treatment for hydrocephalous. Complication of v-p shunt are also mentioned in literature like shunt infection shunt migration etc [8]. Here we are describing a rare complication of vp shunt which barely mentioned in literature. A 22 yr male admitted with complain of headache & vomiting patient was diagnosed to have tubercular meningities with hydrocephalous. Patient planned for ventriculoparietoneal shunt surgery and vp shunt was done. On 3rd post-surgery day patient develop weakness in Left side of body. Urgent ncct head done which showed EDH at surgical site. Immediate craniotomy and evacuation of hematoma was done patient improved and discharged. Thus we are discussing the importance of meticulous surgery for v-p shunt, post op ct scan and treatment

Synthesis of Zinc Oxide Nanoparticles, its characterization and anti-microbial activity assessment

Zinc oxide nanoparticles (ZnO NPs) are one of the most abundant metal oxides nanoparticles. It provides excellent thermal, electrical and chemical stabilities with low biotoxicity; its photo-oxidising and photo-catalytic impact on biological and chemical species is of great importance, thereby making it a promising candidate to be used for in-vitro and in-vivo studies in biomedical field. Hereby, ZnO NPs were synthesized using precipitation method with zinc acetate and sodium hydroxide as starting materials. This study has characterized the synthesized ZnO NPs using different techniques such as UV-Visible spectroscopy indicating a peak at 365 nm wave length, size of ZnO NPs was determined to be 286.7 nm by measuring hydrodynamic radii using Dynamic Light Scattering (DLS) phenomena. Further predominant charge existing at surface of the synthesised ZnO NPs was evaluated to be 31.6mV. Anti-microbial activity of ZnO NPs was determined by Kirby-Bauer method for both Gram-positive and Gram-negative bacteria, S. aureus and E. colirespectively. Anti-microbial activity was determined as Zone of Inhibition that measures both bactericidal and bacteriostatic activity of ZnO NPs and was found to be more potent for Gram-positive (S. aureus)bacteria and its activity increased with increasing concentration of nanoparticles. Growth kinetics was studied to determine percentage growth inhibition, for this optical density was recorded as a function of time in bacterial culture broth with and without treatment. Further DNA fragmentation assay was performed to determine genotoxicity caused by nanoparticles and its effect on genomic DNA of bacteria. Highlighting its potential role as a nano-carrier system for leading antibacterial drugs for enhanced effectiveness of the antibacterial therapie