Art and craft of episiotomy

Background: Episiotomy is the most common obstetric surgical procedure performed in labor room. Mediolateral and Midline episiotomies are the most common types. Post-delivery suture angle is the most important determinant factor which predicts the risk of anal sphincter injuries. Mediolateral episiotomy has a significantly lower risk of OASIS rate when compared to midline episiotomies. Aim of the study was to know whether mediolateral episiotomies are actually mediolateral and does the angle of episiotomy influences the risk of anal sphincter injuries, maternal/fetal complications in the perinatal period.Methods: An observational study was conducted on 250 postpartum patients admitted to our hospital. Details of episiotomy in relation to incision angle, length, depth and post suturing angle were noted within two days of delivery.Results: Among the subjects included there were 40.8 % incisions were RMLE, average length was 3.32cms, average suture angle is 28.69 degree. OASIS was seen in 19.5% cases more so with midline episiotomies.Conclusions: Episiotomy is an essential, must to know skill. Compulsory ssupervised clinical teaching and use of skill lab training can prevent potential detrimental consequences

Extreme events enhance phytoplankton bloom in the south-western Bay of Bengal

253-258A study on MODIS (Moderate Resolution imaging Spectroradiometer)-derived chlorophyll-a concentration data was carried out for 12 years (2003 to 2014), to know the reasons for two episodic phytoplankton bloom events occurred in 2005 and 2013. During the month of December 2005 and 2013, magnitude of the production increased to two to three times of climatological value over the south-western Bay of Bengal region. Reasons for the bloom were examined with the available satellite resources and it was identified that the strong cyclonic eddy, with long residence time, caused the increase of the production. This production intensified when cyclones passed through or were close to the eddy. The vertical mixing enhanced (2013) when very severe cyclonic storms passed through or moved close to the eddy compared to depressions passing over it which caused further intensification of the primary production

Structure is lost incrementally during the unfolding of barstar

Coincidental equilibrium unfolding transitions observed by multiple structural probes are taken to justify the modeling of protein unfolding as a two-state, N⇋U, cooperative process. However, for many of the large number of proteins that undergo apparently two-state equilibrium unfolding reactions, folding intermediates are detected in kinetic experiments. The small protein barstar is one such protein. Here the two-state model for equilibrium unfolding has been critically evaluated in barstar by estimating the intramolecular distance distribution by time-resolved fluorescence resonance energy transfer (TR-FRET) methods, in which fluorescence decay kinetics are analyzed by the maximum entropy method (MEM). Using a mutant form of barstar containing only Trp 53 as the fluorescence donor and a thionitrobenzoic acid moiety attached to Cys 82 as the fluorescence acceptor, the distance between the donor and acceptor has been shown to increase incrementally with increasing denaturant concentration. Although other probes, such as circular dichroism and fluorescence intensity, suggest that the labeled protein undergoes two-state equilibrium unfolding, the TR-FRET probe clearly indicates multistate equilibrium unfolding. Native protein expands progressively through a continuum of native-like forms that achieve the dimensions of a molten globule, whose heterogeneity increases with increasing denaturant concentration and which appears to be separated from the unfolded ensemble by a free energy barrier

A PROSPECTIVE STUDY OF THE PATTERN OF USE OF ANTIMICROBIAL AGENTS IN SURGICAL PROPHYLAXIS IN A TERTIARY CARE CENTRE

Objective: To evaluate the most common class of antimicrobial agents used in surgical prophylaxis. To evaluate the timing, dosage, route and duration of use of antimicrobial agents in surgical prophylaxis.Methods: The study subjects were 214 patients who underwent general surgical procedures at Vinayaka Missions Kirupananda Variyar Medical College from July 2013 to June 2014. The use of antimicrobial agents was noted from the first dose of antibiotic given before the induction of anaesthesia. After surgery was completed the duration of antibiotic in the post-operative ward was noted. Results: Majority of the patients were males of age group 50-60 y and the most common surgical procedure was hernioplasty. Combination therapy with two antimicrobial agents was more preferred regimen 126 (58.9%). Among the antimicrobial agent's cefotaxime 114 (24.8%) was the most commonly prescribed drug and it was followed by metronidazole 121 (21.9%). ceftriaxone 60 (13.1%) was the third most commonly prescribed antimicrobial agent. The mean duration of prescription of antimicrobial agents in the present study was 4.78 d and the mean cost of drug treatment was 787.54 rupees. The cost-effective regimen was that of aminoglycosides and imidazole.Conclusion: The choice of antimicrobial agent was based on the local prevalence pattern of microorganisms. The intravenous administration of antibiotic prophylaxis immediately before or after the induction of anaesthesia is the most reliable method for ensuring effective serum concentration at the time of surgery. The antimicrobial agent chosen must cover all the most likely contaminating organisms

Implementation of Dwell Timer For Fast WiMAX Handoff of Ping Pong Calls

AbstractThe WiMAX technology is becoming the way to avert the impending crisis of rural Connectivity .The next-generation Wireless Metropolitan Area Networks, using the Worldwide Interoperability for Microwave Access (WiMAX) as the core technology is evolving as a Fourth-Generation (4G) technology for providing ubiquitous computing solutions. WiMAX has taken WMAN networks to next level. It is important to analyze the drawbacks in WiMAX networks. Ping pong effect has been one of the major issues in WiMAX networks. The best possible way of avoiding this effect is to prevent the MS from immediately switching to the TBS when communication is in process since it may result in call dropping. Introducing Dwell timer in BS's has been suggested to overcome this effect. This paper deals with the Analysis of the channel performance after implementing Dwell timer by various Modulation techniques. QPSK and BPSK were taken into consideration for the performance analysis. A Comparative study is made on these modulation techniques with respect to factors like throughput and delay

Model simulation of tide-induced currents in Gauthami-Godavari estuary

Predictive spatial distribution of flow field has been simulated from the time series data on currents and tides during dry season (11-19, February, 2009) in the Gauthami-Godavari Estuary utilizing TIDAL model. A 2D-Tidal Estuarine model has been considered (instead of 3D model) due to well-mixed type system and its circulation is dominated by tides during the observational period. The model forcing functions consist of wind and tidal elevations along the open boundaries and no fresh water inflow from the main stream and no land flood in river system. The bathymetry data of the river basin has been collected and supplemented to the model as one of the rigid boundary conditions to evaluate integration. The bottom roughness length (K) was adjusted to achieve model calibration and verification in model simulations of flow field. The model simulation results are in qualitative agreement with the observational data with calibrated bottom roughness length which is about 0.085 m. Model results reveal that the majority of flow was found to be along the channel axis (i.e. high iso-bath contour). During flood time, flow is south-west direction and it is changed to northeast direction during ebb period which is indicating that the model results resemble flow in the real eastern system

Pre-seismic, co-seismic and post-seismic displacements associated with the Bhuj 2001 earthquake derived from recent and historic geodetic data

The 26th January 2001 Bhuj earthquake occurred in the Kachchh Rift Basin which has a long history of major earthquakes. Great Triangulation Survey points (GTS) were first installed in the area in 1856-60 and some of these were measured using Global Positioning System (GPS) in the months of February and July 2001. Despite uncertainties associated with repairs and possible reconstruction of points in the past century, the re-measurements reveal pre-seismic, co-seismic and post-seismic deformation related to Bhuj earthquake. More than 25 M-strain contraction north of the epicenter appears to have occurred in the past 140 years corresponding to a linear convergence rate of approximately 10 mm/yr across the Rann of Kachchh. Motion of a single point at Jamnagar 150 km south of the epicenter in the 4 years prior to the earthquake, and GTS-GPS displacements in Kathiawar suggests that pre-seismic strain south of the epicenter was small and differs insignificantly from that measured elsewhere in India. Of the 20 points measured within 150 km of the epicenter, 12 were made at existing GTS points which revealed epicentral displacements of up to 1 m, and strain changes exceeding 30 M-strain. Observed displacements are consistent with reverse co-seismic slip. Re-measurements in July 2001 of one GTS point (Hathria) and eight new points established in February reveal post-seismic deformation consistent with continued slip on the Bhuj rupture zone

Impact of hybridization and induced mutagenesis on variability of traits and resistance to fusarium wilt in Chickpea (Cicer arietmum L.)

A high yielding and a late wilter variety Bheema was crossed to ICCV-10, also a high yielder but highly-resistant to wilt. The two parents are known to differ in respect of a single gene governing resistance to wilt. The F2 seeds of cross between Bheema and ICCV-10 were subjected to gamma irradiation. Simultaneously, F2 was also advanced to F3 generation. Besides, Bheema was also subjected to irradiation to look to the possibility of developing high yielding and disease resistant mutants. The F2M1 population proved to be highly potential in recovering higher frequency of high yielding and wilt resistant types than selfed (F3) and mutant (M2) populations

Selective Disruption Of Tlr2-Myd88 Interaction Inhibits Inflammation And Attenuates Alzheimer\u27S Pathology

Induction of TLR2 activation depends on its association with the adapter protein MyD88. We have found that TLR2 and MyD88 levels are elevated in the hippocampus and cortex of patients with Alzheimer\u27s disease (AD) and in a 5XFAD mouse model of AD. Since there is no specific inhibitor of TLR2, to target induced TLR2 from a therapeutic angle, we engineered a peptide corresponding to the TLR2-interacting domain of MyD88 (TIDM) that binds to the BB loop of only TLR2, and not other TLRs. Interestingly, WT TIDM peptide inhibited microglial activation induced by fibrillar Aβ1-42 and lipoteichoic acid, but not 1-methyl-4-phenylpyridinium, dsRNA, bacterial lipopolysaccharide, flagellin, or CpG DNA. After intranasal administration, WT TIDM peptide reached the hippocampus, reduced hippocampal glial activation, lowered Aβ burden, attenuated neuronal apoptosis, and improved memory and learning in 5XFAD mice. However, WT TIDM peptide was not effective in 5XFAD mice lacking TLR2. In addition to its effects in 5XFAD mice, WT TIDM peptide also suppressed the disease process in mice with experimental allergic encephalomyelitis and collagen-induced arthritis. Therefore, selective targeting of the activated status of 1 component of the innate immune system by WT TIDM peptide may be beneficial in AD as well as other disorders in which TLR2/MyD88 signaling plays a role in disease pathogenesis

Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011–2017

Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure