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

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

Effects of Voluntary Physical Rehabilitation on Neurogenesis In SVZ And Functional Recovery After Ischemic Stroke

Stroke is the leading cause of long-term disability and 87% of all strokes are due to ischemic strokes. In this current study, we examined whether voluntary physical rehabilitation can influence neurogenesis (measured by Doublecortin) in the subventricular zone and show improved motor functional recovery in 10-12 month female rats after ischemia. We saw a significant increase in the neurogenesis (measured by doublecortin) of all three regions (anterior, middle and posterior) of SVZ in the rehab animals compared to control group when using a two-way variance ANOVA test, although we were unable to see significant differences in paired t-tests of similar regions for control and rehab animals. The control animals showed a significant increase in contralateral functional recovery of 56% with rehab animals displaying a recovery of 23%. These findings suggest that the physical rehabilitation showed increased neurogenesis in the SVZ but did not translate to greater contralateral functional recovery

Effects of Voluntary Physical Rehabilitation on Neurogenesis In SVZ And Functional Recovery After Ischemic Stroke

Stroke is the leading cause of long-term disability and 87% of all strokes are due to ischemic strokes. In this current study, we examined whether voluntary physical rehabilitation can influence neurogenesis (measured by Doublecortin) in the subventricular zone and show improved motor functional recovery in 10-12 month female rats after ischemia. We saw a significant increase in the neurogenesis (measured by doublecortin) of all three regions (anterior, middle and posterior) of SVZ in the rehab animals compared to control group when using a two-way variance ANOVA test, although we were unable to see significant differences in paired t-tests of similar regions for control and rehab animals. The control animals showed a significant increase in contralateral functional recovery of 56% with rehab animals displaying a recovery of 23%. These findings suggest that the physical rehabilitation showed increased neurogenesis in the SVZ but did not translate to greater contralateral functional recovery

Concerted action of Nrf2-ARE pathway, MRN complex, HMGB1 and inflammatory cytokines - Implication in modification of radiation damage

Whole body exposure to low linear energy transfer (LET) ionizing radiations (IRs) damages vital intracellular bio-molecules leading to multiple cellular and tissue injuries as well as pathophysiologies such as inflammation, immunosuppression etc. Nearly 70% of damage is caused indirectly by radiolysis of intracellular water leading to formation of reactive oxygen species (ROS) and free radicals and producing a state of oxidative stress. The damage is also caused by direct ionization of biomolecules. The type of radiation injuries is dependent on the absorbed radiation dose. Sub-lethal IR dose produces more of DNA base damages, whereas higher doses produce more DNA single strand break (SSBs), and double strand breaks (DSBs). The Nrf2-ARE pathway is an important oxidative stress regulating pathway. The DNA DSBs repair regulated by MRN complex, immunomodulation and inflammation regulated by HMGB1 and various types of cytokines are some of the key pathways which interact with each other in a complex manner and modify the radiation response. Because the majority of radiation damage is via oxidative stress, it is essential to gain in depth understanding of the mechanisms of Nrf2-ARE pathway and understand its interactions with MRN complex, HMGB1 and cytokines to increase our understanding on the radiation responses. Such information is of tremendous help in development of medical radiation countermeasures, radioprotective drugs and therapeutics. Till date no approved and safe countermeasure is available for human use. This study reviews the Nrf2-ARE pathway and its crosstalk with MRN-complex, HMGB1 and cytokines (TNF-α, IL-6, IFN-γ etc.). An attempt is also made to review the modification of some of these pathways in presence of selected antioxidant radioprotective compounds or herbal extracts

Prescription audit of a teaching hospital in South India using World Health Organization core prescribing indicators – A cross-sectional study

Aim: World Health Organization (WHO) core prescribing indicators are highly standardized tools in reliably assessing the essential aspects of drug utilization pattern. It is critical that the rational use of drug prescribing is scrutinized for the utmost benefit of patient welfare. In this study, we aim to assess the prescription pattern and prescribing behavior of physicians using the WHO-recommended core prescribing indicators at a teaching hospital in South India. Materials and Methods: A prospective, descriptive cross-sectional study was conducted in the general medicine outpatient department of a tertiary care hospital for a period of 1 month in June 2019. A total of 600 prescriptions were sampled based on the WHO “How to investigate drug use in health facilities” document recommendation. The WHO guidelines and methods were observed to ensure data reliability. Descriptive statistical analyses such as frequencies, percentages, mean, and standard deviation were used to present the data. Results: The WHO core prescribing indicators analysis revealed that the average number of drugs per encounter was 2.38 ± 1.1 and only 796 (55.4%) of the drugs were prescribed by generic name. Whereas, the percentage of encounters prescribed with an antibiotic 44 (7.3%) and an injection 63 (10.5%) was less than the ideal recommendations as per WHO and 1265 (88%) of the drugs were prescribed from the National List of Essential Medicines. Conclusion: This study on prescription pattern audit done using the WHO core prescribing indicators highlights that prescriptions encountered with antibiotic and injection use were in accordance with the WHO recommendations