Prediction of successful vaginal birth after caesarean section based on Flamm and Geiger scoring system a prospective observational study

Background: The aim of this study was to evaluate the adequacy of Flamm and Geiger scoring system in prediction of successful vaginal birth after caesarean section.Methods: A prospective observational study was carried out on 75 pregnant women with previous one caesarean section in department of obstetrics and Gynecology, St Stephen’s hospital, New Delhi over a period of one year.Results: In the present study, out of 75 patients, 40% patients had successful VBAC and 60% patients had emergency LSCS. Among successful VBAC 70% patients had spontaneous vaginal delivery, while 23.3% patients had vacuum assisted and 6.7% had forceps assisted vaginal delivery. Most of the patients with total Flamm and Geiger score 4 had successful VBAC. There were 53.3%, 75%, 85.7% and 100% probabilities of Successful VBAC with total score 4,5,6 and >8 respectively.  Mean score for successful VBAC was 5±1.66and for emergency caesarean was 2.97±0.83.Conclusions: As total Flamm and Geiger score increases, a chance of successful VBAC increases. Application of Flamm and Geiger scoring gives fare judgment of successful vaginal birth in TOLAC and reduces the rate of failed trial leading to emergency caesarean section, thus improving outcome in a trial of labor

Effects of Bt-cotton on biological properties of Vertisols in central India

Growing areas under transgenic crops have created a concern over their possible adverse impact on the soil ecosystem. This study evaluated the effect of Bt-cotton based cropping systems on soil microbial and biochemical activities and their functional relationships with active soil carbon pools in Vertisols of central India (Nagpur, Maharastra, during 2012–2013). Culturable groups of soil microflora, enzymatic activities and active pools of soil carbon were measured under different Bt-cotton based cropping systems (e.g. cotton-soybean, cotton-redgram, cotton-wheat, cotton-vegetables and cotton-fallow). Significantly higher counts of soil heterotrophs (5.7–7.9 log cfu g−1soil), aerobic N-fixer (3.9–5.4 log cfu g−1soil) and P-solubilizer (2.5−3.0 log cfu g−1soil) were recorded in Bt-cotton soils. Similarly, soil enzymatic activities, viz. dehydrogenase (16.6–22.67 µg TPF g−1 h−1), alkaline phosphatase (240–253 µg PNP g−1 h−1) and fluorescein di-acetate hydrolysis (14.6–18.0 µg fluorescein g−1 h−1), were significantly higher under Bt-cotton-soybean system than other Bt- and non-Bt-cotton based systems in all crop growth stages. The growth stage-wise order of soil microbiological activities were: boll development > harvest > vegetative stage. Significant correlations were observed between microbiological activities and active carbon pools in the rhizosphere soil. The findings indicated no adverse effect of Bt-cotton on soil biological properties

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Taking stock of 10 years of published research on the ASHA programme: Examining India’s national community health worker programme from a health systems perspective

Background: As India’s accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW–health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

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