A cross sectional study of rate, indications and complications of primary caesarean section

Background: The indications for cesarean sections have been undergoing a gradual change over the last few decades. Besides the obstetric causes, several other medical, social, ethical, economic and medico legal factors play a role in this rising trend of cesarean section. Initially it was performed mainly for maternal interest but recently the health of the fetus has played a significant role in making the decision for a cesarean birth. This study was conducted to determine the rate, indications and complications of primary cesarean section in primi and multiparae.Methods: This was a cross sectional study carried out on primary cesarean section in the Department of Obstetrics and Gynecology, P.D.U. Medical College and Hospital, Rajkot during one year period from April 1, 2014 to March 31, 2015. During this study, patients (booked or unbooked) attending the labour room, undergoing primary cesarean section in the department will be selected according to the inclusion criteria. Their intraoperative and postoperative complications would be noted and also maternal and fetal morbidities and complications if any. The study does not include women who had Gestational age of less than 28 weeks, who underwent cesarean section in previous pregnancy, previous uterine surgery or hysterotomy and who had multiple gestations.Results: Out of 7295 deliveries performed during one year period, overall 1349 CS were performed with an incidence of 18.5%. The frequency of primary cesarean section was higher in primipara (72.4%) than multipara (27.6%) women. Emergency cesarean section (79.3%) was performed more than elective cesarean section (20.7%) in both the study group and most of them, did not taken ANC. 28.5% of the patients were unbooked and 46.6% of the patients were referred. Illiteracy was present in 31.7% cases and 62.6% cases belonged to rural areas. Anemia, malpresentations, oligohydramnios, eclampsia and preeclampsia were more common antenatal complications in primipara patients than multipara patients, while APH was more common complication in multiparity. In unbooked patients, anemia was found more commonly. Malpresentation (34.3%) was the commonest indication for cesarean sections in both the study groups.  Intraoperative complications like extension of uterine incision, placenta praevia, PPH were found more in caesarean section done in emergency than electively and more in multipara patients. Maternal morbidity was seen in 18.5% of cases and more in multipara (25.4%) than primipara (15.9%). Abdominal distension, wound gap and fever were the common morbidities while no maternal mortality in the present study. 330 out of 685 babies were admitted in NICU and majority of them were for jaundice, preterm care and birth asphyxia. Perinatal mortality in the study was 6.6% and among them antepartum hemorrhage has the highest perinatal mortality rate. Prematurity was the most common cause of neonatal deaths.Conclusions: From this tudy, we concluded that overall CS rate is 18.5% and rate of vaginal delivery is 82.1% of the present study from 1st April 2014 to 31st March 2015. While primary cesarean section rate is 55.8%, more in primipara as compared to multipara. The malpresentation was the major indication in primary cesarean section, in both primipara and multipara women in our community, while APH is still a major problem of the multiparity. Anemia, malpresentation, eclampsia and preeclampsia were more common antenatal complications in primipara while APH was antenatal complication in multiparity. Malpresentation (34.3%) was the commonest indication for cesarean section in both the groups

Including costs of supply chain risk in strategic sourcing decisions

Thesis (M. Eng. in Logistics)--Massachusetts Institute of Technology, Engineering Systems Division, 2009.Includes bibliographical references (leaves 61-62).Cost evaluations do not always include the costs associated with risks when organizations make strategic sourcing decisions. This research was conducted to establish and quantify the impact of risks and risk-related costs on sourcing decisions for the automotive industry. The focus is on comparing distant, global suppliers entailing long supply chains with domestic, US-based suppliers. The risk factors effecting supplier selection were classified into eight categories. A model was developed using Monte Carlo simulation for scenario generation and Value-at-Risk methodology from finance theory for developing the risk-cost relationship. The model was tested using multiple scenarios which were generated by varying the risk profiles of suppliers. The results indicate that there is distinct and quantifiable relationship between supplier-related risk and total costs of sourcing. Furthermore, under high risk conditions, distant, global suppliers with relatively lower contract costs can exceed cost budgets as well as the cost of domestic sourcing. The model developed through this research can be used to compare two or more suppliers and map the total cost variation for suppliers under particular risk scenarios. Thus, the model can be used for strategically selecting low-cost and long-term suppliers.by Avani Jain.M.Eng.in Logistic

A Correlation of Tumor Budding and Tumor Stroma Ratio with Clinicopathological Factors in Oral Squamous Cell Carcinoma

Background: Squamous cell carcinoma is the most common carcinoma in the head and neck region. Both tumor budding and tumor stroma ratio are being studied in the recent years in various solid tumors for their role as a prognostic marker, however the studies in oral squamous cell carcinoma are limited. Methods: A total of 50 patients of oral squamous cell carcinoma proved histologically were included in the study over a period of 4 months (July 2022-October 2022). Tumor budding(TB) and Tumor stroma ratio (TSR) were evaluated on routine hematoxylin and eosin stained sections and these were correlated with clinicopathological parameters. Statistical analysis was done using Chi-square test and p value <.05 considered significant. Result: The mean age was 52.72 +_ 13.16 and M: F of 7.1:1. Most of the tumors were located on tongue (46%) followed by buccal mucosa (26%), gingivobuccal sulcus (12%) and retromolar trigone (8%). Palate and alveolus were the other sites involved constituting 4% each. Both TB and TSR were found to be significantly associated with grade of the tuumor, lymph node metastasis and size of the tumor. A highly significant correlation was also found between Tb and TSR with a p value <.001. Conclusion: Both TB and TSR can be easily evaluated on routine H&E sections and are highly reproducible and found to be reliable independent prognostic markers in OSCC. Thus, this simple and cost-effective method of prognostification which is currently lacking will help in identifying patients with poor prognosis and thus, individualise the treatment plan. Keywords: Tumor Budding, Oral squamous cell carcinoma, Tumor stroma ratio

Dopamine Transporter imaging with Tc-99m TRODAT-1 SPECT in Parkinson’s disease and its correlation with clinical disease severity

Objective(s): To evaluate the role of Tc-99m TRODAT-1 Single Photon Emission Computed Tomography (SPECT) in Parkinson’s Disease (PD) by assessing the correlation of clinical disease severity, disease duration and age at onset of disease with specific uptake ratio of Tc-99m TRODAT-1 in striatum.Methods: The study included 63 patients in age range of 40-72 years with clinical diagnosis of PD and nine controls. Clinical history of patients was obtained regarding age at onset of disease and disease duration. Disease severity in each patient was assessed using H and Y stage and UPDRS. Tc-99m TRODAT-1 SPECT was performed and specific uptake ratios were calculated for six regions in bilateral striata, caudate nuclei and putamina. Difference in specific uptake ratios between different stages of disease was analyzed for statistical significance. Specific uptake ratios were correlated with UPDRS, motor score of UPDRS, duration of disease and age at onset of disease using Pearson’s correlation co-efficient.Results: Median specific uptake ratio was found to be least in contralateral putamen for all H and Y stages. There was a statistically significant difference between specific uptake ratios of controls vs stage 1, stage 1 vs 2, 1 vs 3, 1 vs 4, and 2 vs 4 for all 6 regions. The difference in uptake ratio between 3 and 4 H and Y stages was significant only for contralateralregions. There was no significant difference in uptake ratio between 2 and 3 H and Y stages. The uptake ratios showed a strong negative correlation with UPDRS and motor score, a weak negative correlation with duration of disease and no significant correlation with age at onset of disease.Conclusion: We conclude that Tc-99m TRODAT-1 SPECT can be used to assess the disease severity in PD patients

Adenoid Hypertrophy in Adults: An Underdiagnosed Entity?

Adenoid enlargement is uncommon in adults. We studied the varied presentation of adenoid hypertrophy in two adults. A 45 year old male who presented with nasal obstruction and snoring, and a 35 year old male who presented with non resolving chronic otitis media. In both the patients, adenoid hypertrophy was diagnosed by nasal endoscopy and confirmed by CT scan. Adenoidectomy in these patients resulted in symptomatic improvement. Therefore, adenoid hypertrophy should also be considered as a cause or contributing factor in nasal obstruction and related pathologies in adults.&nbsp;</p

Study of biomarkers p53, Ki-67, Bcl-2, and VEGF in pterygium

Purpose: To study the biomarkers present in primary pterygium samples of patients of Indian ethnicity and compare it with the samples obtained from the unaffected conjunctiva of the same eye. Methods: A prospective case-control study of 17 eyes in patients above 10 years of age with primary pterygium who underwent pterygium excision using limbal conjunctival autograft technique. The pterygium samples (cases) and conjunctival samples (controls) were sent for immunohistochemical (IHC) staining for the following biomarkers: p53, Bcl-2, Ki-67, and vascular endothelial growth factor (VEGF). Result: The immunohistochemistry of the samples and the controls revealed p53 positivity in 47.05% of pterygium samples and 29.4% of controls (P < 0.587). Nine cases each in pterygium and control samples were positive for Ki-67 expression. Differences in the staining pattern between the two groups were not statistically significant (P < 1.000). Bcl-2 positivity was seen in 10 pterygium samples (58.8%) and 12 controls (70.5%), with no statistical difference between the two groups (P < 0.455). VEGF expression was seen in both epithelial and endothelial cells of the samples and controls, with no statistical difference between the two groups, with P = 1.000 for the epithelial staining and P = 0.637 for endothelial staining. Conclusion: The expression of biomarkers was comparable in both groups. We conclude that pterygium, against common belief, might not be a localized disease process but a global ocular phenomenon where the apparently healthy tissue also has some ongoing disease process at a molecular level

Parotid tuberculosis: A diagnostic dilemma

Tuberculosis of the parotid gland is a rare condition, even in endemic countries. It usually presents as a slow growing swelling, which can be mistaken for a neoplasm of the parotid gland. Diagnosis is by high suspicion and demonstration of epithelioid granulomas on fine needle aspiration cytology (FNAC). Herein, we report a case of parotid tuberculosis, secondary to pulmonary tuberculosis, in a 50-year-old female patient diagnosed by FNAC and treated successfully with anti-tuberculosis regimen

Surgical management of complex odontoma associated with agenesis of a molar

Odontomas are mixed odontogenic tumors composed of mineralized tissue of ectomesenchymal origin. These are usually detected in routine radiographs and may have a variable etiology such as local trauma, genetic mutation, or infection. They are classified into two main types: complex and compound. Complex odontomas are rare and they rarely erupt into the oral cavity as they lack periodontal ligament. This is the report of one such case of complex odontoma where an 11-year-old girl reported with an asymptomatic swelling, in relation to the left angle of the mandible. The case report highlights the clinical and radiographic findings, investigations done to arrive at the diagnosis and the treatment rendered. This report is of clinical importance because of its rare association with the agenesis of a molar tooth