Efficacy of Intra Vaginal Misoprostol as Various Doses versus Intra cervical Dinoprostone in Cervical Ripening and Induction of Labor

Objective: To compare the efficacy of intra vaginal misoprostol as various doses versus intra cervical dinoprostone in cervical ripening and induction of labor.Study Design: A Prospective Randomized Controlled Trial.Place and Duration of Study: Obstetrics and Gynecology Department of Nishtar Medical University and Hospital, Multan from May 2016 to July 2018.Methodology: We divided 168 patients into three groups; Group M1 and M2 were given 25µg and 50µg misoprostol, respectively; Group D was given 0.5mg dinoprostone. Complete history was followed by complete examination. Outcome variables, age, parity, gestational age, indications for the induction of labor and initial Bishop Score were compared. Data was put in SPSS 23 and analyzed by applying one way ANOVA and Chi-square tests, as appropriate considering p≤0.05 statistically significant.Results: Induction to vaginal delivery interval was 15.51±6.18min in Group-M1, 12.14±4.65min in Group-M2 and 13.43±6.96min in Group-D (p=0.008). The women who need oxytocin supplementation were 30.6%, 17.7% and 41.9% from Group M1, M2 and D, respectively (p=0.013). Bishop Score after 6 hours of delivery was 3.45±1.2, 4.41±1.5 and 4.21±1.3 in group M1, M2 and D, respectively, and the difference was highly statistically significant (p<0.001). All other variables were comparable among the groups (p>0.05).Conclusion: Higher dose of misoprostol i.e. 50µg misoprostol is higher in efficacy than 0.5mg dinoprostone which is in turn better than 25µg misoprostol. But 50µg misoprostol can cause hyper-stimulation and dinoprostone needs oxytocin augmentation. Misoprostol is a good and cheap agent for the induction of vaginal delivery. Keywords: misoprostol, dinoprostone, cervical ripening, induction of labor.

Frequency of Adverse Maternal and Neonatal Outcomes in Patients with Low Serum Fibrinogen Level and Placental Abruption

Objective: To assess frequency of adverse maternal and neonatal outcomes in patients with low serum fibrinogen level and placental abruption.Place and duration: It was held in Gynecology Department Nishtar Hospital Multan from 12 November 2017 to 25 July 2018.Study Design: Case control retrospective study.Methodology: A total of 100 patients were included in this clinical trial and they were diagnosed with placental abruption. They were categorized on the basis of serum fibrinogen level into three groups; high fibrinogen group (400-600 mg/dL), normal fibrinogen group (300-400 mg/dL) and low fibrinogen group (<200 mg/dL). . The pregnant women with uterine rupture, wound of birth canal, placental accrete, placental praevia, HELLP syndrome, severe preeclampsia, monochorionic multiple pregnancies, major fetal anomalies and sign of intrauterine infection were excluded and all other women with single or more pregnancies were eligible for this clinical study. Computer software SPSS version 23.2 was used for entering and analyzing data. Frequency and percentage was calculated for baseline variables. Frequency and percentage was calculated for laboratory parameters. Frequencies and percentage was calculated for maternal and neonatal outcome variables like mode of delivery, PIH, GDM A, postpartum hemorrhage (PPH), postpartum anemia (PPA), FFP and RCC transfusion, ISTH DIC score, delay discharge from hospital, fetal death, Apgar score at 5 min <7, birth weight, still birth, umbilical artery pH < 7.00, neonatal gestational age and IUFG. ANOVA test was used to find frequency and percentage. P value was < 0.05 was considered to be significant.Result: 100 patients were included in this study and they were divided on the basis of serum fibrinogen level into three groups i.e. n=40 high Fibrinogen group (400-600 mg/dL), n=35 normal Fibrinogen group (300-400mg/dL) and n=25 low Fibrinogen group (<200mg/dL). All the data recorded from all three groups regarding PIH, GDM, FFP, RCC transfusion, ISTH DIC score, delayed discharge from hospital was insignificant. The differences were statistically significant of postpartum hemorrhage PPH (p=0.001) and postpartum anemia PPA (p=0.002). The data recorded from three groups regarding, Apgar score at 5 min <7, Birth weight (g), Umbilical artery pH < 7.00 and intrauterine fetal growth was statistically insignificant. The statistical differences observed in three groups were as; fetal death (p=0.047), still birth (p=0.016), and gestational age (weeks) (p= 0.001) respectively.Conclusion: It has been concluded that low serum fibrinogen level has higher frequency of adverse maternal and neonatal outcomes including postpartum hemorrhage (PPH), postpartum anemia (PPA), fetal death, small gestation age of neonates and still birth than normal and high serum fibrinogen level. Keywords: Low serum fibrinogen, Placental Abruption, Maternal, Neonatal outcomes

Role of Occiput Spinal Angle-A Novel Sonographic Index to predict the outcome of labour

Introduction: The attitude (relationship of head of a fetus to the cervical spine) in the first stage of labour has a significant impact on the outcome of labour. Deflexion of the fetal head is determined by digital vaginal examination during labour. However, different ultra-sonographic indexes have been developed to predict labour outcomes. Occiput spine angle (OSA) is a novel ultra-sonographic marker which can be used to predict operative delivery. Objective: To determine the effect of the occipital spinal angle measured through transabdominal ultrasound during the first stage of labour on the labour outcome. Materials and Methods: This prospective cross-sectional study was carried out at Department of Obstetrics and Gynecology Unit 2, Holy Family Hospital, Rawalpindi from June 2020 to Dec 2020 which included 380 low-risk pregnant women in the first active stage of labour. Occipital-spine angle (OSA) was defined as the angle formed by the fetal occiput and the cervical spine on the sagittal plane at the transabdominal ultrasound. For each case, the angle was calculated twice and independently by the 2 radiologists who were unaware of labour outcome to minimize intra and inter-observer error. Data were analyzed using SPSS version 23.0. P-value ≤ 0.05 was considered significant. Results: Incidence of operative delivery was 17.2%. A cut-off value of 1260125.50 of OSA had a sensitivity of 92.3% and specificity of 98.1% to predict operative delivery. Binary Logistic Regression showed that gestational age, OSA, and Head station are significant with the OR= 1.15, 0.711, and 0.32 respectively. Conclusion: OSA is a good predictor of operative delivery at a cut-off value of 1260. It should be determined at routine ultrasound booking during pregnancy. More studies should be conducted to highlight its importance. &nbsp

The role of integrated offline/online social activity and social identification in Facebook citizenship behaviour formation

Purpose<: Drawing on social identity theory and prosocial behaviour research, this study explores how people's integration of their offline and online social activities through Facebook cultivates their Facebook citizenship behaviour (FCB). It also offers further insight into the underlying mechanism of offline and online social activity integration - FCB relation by investigating people's social identification with their offline and online social groups as possible mediators. Design/methodology/approach: Based on social identity theory (SIT) literature, community citizenship behaviour and offline-online social activity integration through Facebook, we developed a conceptual model, which was empirically tested using data from 308 Facebook users Findings: The results confirm that the participants' offline-online social activity integration via Facebook is positively linked to their FCB. Further, the integration of offline and online social activity through Facebook positively affects how a person identifies with their offline and online social groups, which in turn causes them to display FCB. In addition, offline/online social identification mediates the integration – FCB relation. Practical implications: In practice, it is interesting to see people's tendency towards altruistic behaviours within groups they like to associate themselves with. Those who share their Facebook network with their offline friends can use such network to seek help and support. Originality/value: From a theoretical perspective, unlike past research, this study examines how individuals' offline-online social activity integration via Facebook helps them associate with groups. In addition, this study investigates social identification from an offline and online perspective

Comparison of chest HRCT severity score in PCR positive and PCR negative clinically suspected COVID-19 Patients

Background: The limitations and false-negative results of Real-time Polymerase chain reaction (RT PCR) in diagnosing COVID-19 infection demand the need for imaging modalities such as chest HRCT to improve the diagnostic accuracy andassess the severity of the infection. Objectives: The study aimed to compare the chest HRCT severity scores in RT-PCR positive and negative cases of COVID-19. Methods: This cross-sectional study included 50 clinically suspected COVID-19 patients. Chest HRCT and PCR testing of all 50 patients were done and the chest HRCT severity scores for each lung and bronchopulmonary segments were compared in patients with positive and negative PCR results. Chi-square and Mann Whitney U test were used to assess differences among study variables. Results: Chest HRCT severity score was more in PCR negative patients than in those with PCR positive results . However, the difference was not significant (p=0.11). There was a significant association in severity scores of the anterior basal segment of the left lung (p=0.022) and posterior segment upper lobe of right lung (p=0.035) with PCR results. This association was insignificantfor other bronchopulmonary segments (p&gt;0.05). Conclusion: CR negativity does not rule out infection in clinically suspected COVID-19 patients. The use of chest HRCT helps to determine the extent of lung damage in clinically suspected patients irrespective of PCR results. Guidelines that consider clinical symptoms, chest HRCT severity score and PCR results for a confirmed diagnosis of COVID-19 in suspected patientsare needed. Keywords: Chest High resolution computed tomography (HRCT); COVID-19; Polymerase Chain Reaction (PCR)

Aloe vera and carrageenan based edible film improves storage stability of ice-cream

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Machine learning model for automated assessment of short subjective answers

Natural Language Processing (NLP) has recently gained significant attention; where, semantic similarity techniques are widely used in diverse applications, such as information retrieval, question-answering systems, and sentiment analysis. One promising area where NLP is being applied, is personalized learning, where assessment and adaptive tests are used to capture students' cognitive abilities. In this context, open-ended questions are commonly used in assessments due to their simplicity, but their effectiveness depends on the type of answer expected. To improve comprehension, it is essential to understand the underlying meaning of short text answers, which is challenging due to their length, lack of clarity, and structure. Researchers have proposed various approaches, including distributed semantics and vector space models, However, assessing short answers using these methods presents significant challenges, but machine learning methods, such as transformer models with multi-head attention, have emerged as advanced techniques for understanding and assessing the underlying meaning of answers. This paper proposes a transformer learning model that utilizes multi-head attention to identify and assess students' short answers to overcome these issues. Our approach improves the performance of assessing the assessments and outperforms current state-of-the-art techniques. We believe our model has the potential to revolutionize personalized learning and significantly contribute to improving student outcomes

Constructive Voice Behavior for Social Change on Social Networking Sites: A Reflection of Moral Identity

Social networking sites (SNSs) have enabled people to voice their concerns by making their voices heard and hence initiate social change. Constructive voice behavior concerning societal matters, mediated by SNSs, is a much under-explored area and requires investigation. Primarily, voice literature has mainly discussed voice behavior within organizations focused on employees. However, individuals, as members of society, are using social media websites to voice about social change in the form of condemning harmful practices in society and/or promoting social good. Drawing from the self-consistency theory, this study explores the role of an individual’s moral identity as an antecedent of constructive voice behavior on SNSs. Hierarchical multiple regression analysis results of 226 SNSs users, provide support to the self-consistency theory-based moderated-mediation model in which the positive relationships, between individual’s moral identity and the promotive-prohibitive voice on SNSs, were mediated by the felt responsibility for constructive change (FOCC). Further, proactive personality moderates the positive mediation effect of FOCC between moral identity and prohibitive voice but not for promotive voice, such that the mediation effect would be stronger for individuals with a high-proactive personality than those of with a low-proactive personality. This study contributes to both voice and social media research in a number of ways

Effects of coagulation on the two-phase peristaltic pumping of magnetized Prandtl biofluid through an endoscopic annular geometry containing a porous medium

In this article, motivated by more accurate simulation of electromagnetic blood flow in annular vessel geometries in intravascular thrombosis, a mathematical model is developed for elucidating the effects of coagulation (i.e. a blood clot) on peristaltically induced motion of an electrically-conducting (magnetized) Prandtl fluid physiological suspension through a non-uniform annulus containing a homogenous porous medium. Magnetohydrodynamics is included owing to the presence of iron in the hemoglobin molecule and also the presence of ions in real blood. Hall current which generates a secondary (cross) flow at stronger magnetic field is also considered in the present study. A small annular tube (endoscopic) with sinusoidal peristaltic waves traveling along the inner and outer walls at constant velocity with a clot present is analyzed. The governing conservation equations which comprise the continuity and momentum equations for the fluid phase and particle phase are simplified under lubrication approximations (long wavelength and creeping flow conditions). The moving boundary value problem is normalized and solved analytically (with appropriate wall conditions) for the fluid phase and particle phase using the homotopy perturbation method (HPM) with MATHEMATICA software. Validation is conducted with MAPLE numerical quadrature. A parametric study of the influence of clot height (δ), particle volume fraction (C), Prandtl fluid material parameters (α, β), Hartmann number (M), Hall parameter (m), permeability parameter (k), peristaltic wave amplitude (φ) and wave number (δ̅ ) on pressure difference and wall shear (friction forces) is included. Pressure rise is elevated with clot height, medium permeability and Prandtl rheological material parameters whereas it is reduced with increasing particle volume fraction and magnetic Hartmann number. Friction forces on the outer and inner tubes of the endoscope annulus are enhanced with clot height and particle volume fraction whereas they are decreased with Prandtl rheological material parameters, Hall parameter and permeability parameter. The simulations provide a good benchmark for more general computational fluid dynamics studies of magnetic endoscopic multi-phase peristaltic pumping