Effectiveness of first trimester ultrasound screening in reduction of postdated labor induction rate

Background: The gestational age calculation by ultrasonography (USG) at first trimester is based on crown-rump length is more accurate, less erratic than last menstrual period based dating. Utilization of first trimester based scanning in dating the pregnancy will reduce the labor induction rate and consequently reduce the morbidity related to induction of labor.Methods: A comparative cross-sectional study was done among 314 booked antenatal women visiting department of obstetrics and gynecology, BPKIHS for regular check-up between 37 and 41 weeks of gestation. Expected date of delivery was calculated from crown rump length (CRL) of the first trimester scan for USG group while last menstrual period was taken to calculate expected date of delivery for LMP group and were called for induction at 41 weeks of gestation. The rates of labor induction, emergency cesarean section (CS) among induced group, indication of CS and mode of delivery were compared in both the groups.Results: There was 14% labor induction rate in USG group and 24.2% in LMP (last menstrual period) group and differed significantly (p=0.022). There was no difference in the mode of delivery among participants in either groups. The rate of emergency CS among women undergoing induction of labor was 54.5% and 39.5% respectively for USG and LMP groups (p=0.258). Overall, non-reassuring fetal heart rate was the most common indication for CS in both the groups.Conclusions: The finding suggests first trimester scan among all pregnancies will reduce the post-dated inductions, as well as need of CS.

Experience in laparoscopic cholecystectomy in Nobel Medical College, Nepal

Objective: A laparoscopic cholecystectomy (LC) is the treatment of choice for gallbladder diseases. The aim of this study is to analyze laparoscopic cholecystectomies performed by a single surgeon over 8 years at Nobel Medical College Teaching Hospital and Research Centre Pvt. Ltd. of Biratnagar, Nepal (NMCTH). Methods: We performed a retrospective analysis of 7557 patients that underwent a LC by a single surgeon, from October 2010 to July 2018. We divided it into 3 groups that include data of every three years. Results: The hospital stay, operation time and conversion rates were decreased by years of experience. Female patients outnumbered male (M:F=1:3.7) patients in this study. The hospital stay (3 days), operation time (21 min), conversion (0.3%) and complications (1.9%) rates decreased from Group 1 to Group 3 (p<0.05). Conclusion: As surgical experience increased with a rising number of cases, the conversion rate, complications, hospital stay and mean operation time decreased. Key words: cholecystectomy, laparoscopy, elective, conversion, complications, mortality, gallstone, cholecystiti

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The Role of Gender in Agricultural Productivity in the Philippines: The Average Treatment Effect

Using average treatment effect and data from 2012 the Central Luzon Loop Survey, this study investigates the role of gender in rice production. Results indicate that female-headed farm households, despite having limited access to land, have a higher value of rice production than their male counterparts. However, there is no significant difference between net farm incomes earned by male- and female-headed farm households. Female-headed households have higher fixed costs, consequently earning less total household income. Findings from this study indicate that women are less efficient in farming, but are more likely to adopt improved seed varieties. In addition, female-headed farm households are better at controlling farming costs

Determinants of Rice Productivity and Technical Efficiency in the Philippines

Agricultural production determines the efficiency level of households in their farming activities. In the developing countries farmers do not use all potential technological resources, thus making inefficient decisions in their agricultural activities. So, this paper focuses to measure the technical efficiency of rice production and identified determinants of technical efficiency of rice farmers in Philippines. The Loop Survey of the Institute of Rice Research Institute (2007-2012) was analyzed using stochastic frontier production method in the Cobb-Douglas functional form. Result shows that fuel, fertilizer, land rent, planting season, and land area are the factors that affect both production and technical efficiency of rice production. We found mean technical efficiency score of 0.54

Impact of Land Ownership on Productivity and Efficiency of Rice Farmers: A Simulated Maximum Likelihood Approach

This paper investigates the factors affecting rice production and technical efficiency of rice farmers in Philippines. Particular attention is given to the role of land ownership. We use the 2007-2012 Loop Survey from the Institute of Rice Research Institute (IRRI) and simulated maximum likelihood (SML) approach. Results show that land ownership plays an important role in rice production. In particular, compared to owner operators, farmers who lease land are less productive. Additionally, result shows that land area, irrigation and labor cost are significant factors affecting rice production. We found mean technical efficiency score of 0.82. Finally, educated females, farmers leasing land and dry season farming tend increase technical inefficiency

Participation in Agritourism and Off-farm Work: Do Small Farms Benefit?

Small farms face significant challenges using conventional crop production methods. They seek methods of generating alternative income both on- and off the farm. The literature considers these opportunities individually; however recent evidence shows that small farms engage in both activities simultaneously. This study analyzes factors influencing such choice decisions and their impact on farm and total household incomes. Using a large nation-wide farm survey data and selectivity based multinomial choice model, we found that small farms have higher household income if they chose a combination of both strategies rather than a single strategy. Additionally, education, age of the operator, financial conditions of the farm and location of the farm are important factors deriving alternative choice decisions for income diversifications