Role of Color Doppler in predicting perinatal outcome in preeclampsia

Background: Preeclampsia is one of the most common complications of pregnancy, which increases both fetal and maternal mortality and morbidity. Since preeclampsia is characterized by abnormal placenta formation leading to inadequate uteroplacental blood flow, Doppler ultrasonography can prove to be a useful tool to assess fetal outcome in PIH patients. Through this study, we sought to determine the perinatal outcome on the basis of Doppler changes seen in Umbilical and Middle Cerebral artery.Methods: This was a prospective study conducted from September 2014 to August 2017 in a tertiary care hospital where 150 singleton pregnant patients with preeclampsia were examined with Doppler ultrasound of the Umbilical artery and Middle cerebral Artery. Serial Doppler examination was performed and the results of the last Doppler examination within 10 days of delivery was considered. Perinatal outcome was studied in the form of perinatal death, mean APGAR at 1 and 5 minutes, birth weight and admission to Neonatal Intensive Care Unit (NICU).Results: Abnormal Doppler velocimetry of the umbilical artery (increased resistance, AEDV, REDV) were significantly associated with poor perinatal outcome in the form of low birth weight, APGAR of ≤7 at five minutes of birth and NICU admission. However, S/D ratio of the Middle cerebral artery could not positively predict poor perinatal outcome in this study.Conclusions: Doppler technology has provided the best opportunity for repetitive non-invasive hemodynamic monitoring in human pregnancy. Umbilical artery Doppler findings are slight better predictor of adverse perinatal outcome than an abnormal MCA

A rare case report of ovarian torsion with sigmoid volvulus

Ovarian torsion results from twisting of the ovary about the suspensory ligament, which contains the ovarian artery and vein, lymphatic’s, and nerves. Volvulus is a torsion of a segment of the alimentary tract, that often leads to intestinal obstruction. Ovarian torsion leading to sigmoid volvulus is the rarest complication which authors found in this case. Hence the case was presented. A 28-year-old women presented with acute pain in abdomen since 14 hours, followed by 2 episodes of vomiting, abdominal distension since 10 hours. Plain X-ray Abdomen erect was done which showed ‘Coffee bean’ sign with multiple air fluid levels suggestive of sigmoid volvulus. On laparotomy, after opening the peritoneum, large right ovarian cyst around 12×11×10 cm with solid and haemorrhagic content with long pedicle around 8 cm with 3 turns of torsion was noted. Abutting the ovarian mass, sigmoid colon was seen twisted around its mesentery including the twisted ovarian pedicle. Hence, the twisted component included the twisted ovarian pedicle and twisted sigmoid mesentery. Stepwise detorsion of ovarian pedicle followed by oophorectomy was done. For sigmoid volvulus, resection of vascular compromised sigmoid colon and descending colon stoma was done. Reanastomosis was done later after 3 months post operatively

An interesting case report of ruptured pyogenic liver abscess with 40 weeks gestation in labour

Pyogenic liver abscess during pregnancy is an extremely rare condition. Although rare, in situations of sepsis or septic shock in pregnancy, as well as the common sources of infection, a possibility of a liver abscess should be considered. We present a case report of 32-year-old primigravida 37.3 weeks by date, 37 weeks by scan with breech presentation with premature rupture of membranes and pain in abdomen since 12 hours with breathlessness, fever and diarrhoea since 2 days came in emergency to study hospital. General condition of the patient on arrival was pulse-140 beats per minute, blood pressure was 90/60 mmHg, respiratory rate was 40/min, on per abdominal examination, breech presentation with fetal heart rate of 150 beats per minute on doppler was noted. Per vaginal examination revealed cervical os 5 cm dilated, 40% effacement, breech presentation, absent membranes. With urgent report of complete hemogram and acid blood gas analysis, metabolic acidosis was noted which was corrected and patient was taken for emergency lower segment caesarean section. Intra-operative, 250 ml greenish pus flakes fluid was noted inside the abdominal cavity. Fluid was drained and sent for culture sensitivity with maximum aseptic precautions, uterus was opened, baby was delivered followed by uterus closure. Ruptured liver abscess 6×4×2 cm in 2nd and 3rd segment of liver was noted, abdominal wash with antibiotics and NS was given, drain was kept. Appropriate antibiotics were started and was discharged on day 14 after suture removal

A prospective study to compare the efficacy and safety of tioconazole and clotrimazole vaginal gel in patients suffering from vulvovaginal candidiasis

Background: Vulvo vaginal candidiasis is an extremely common gynaecological condition. While clotrimazole has been the mainstay of treatment of this pathology, newer medications are now available. The study aims to compare the efficacy, compliance and safety of tioconazole single dose intravaginal gel application and clotrimazole vaginal gel for 3 days in patients suffering from vulvovaginal candidiasis.Methods: A prospective, multicentric, open label, randomized, controlled, parallel group clinical trial of 220 women with 110 in each group for the evaluation of the effects of tioconazole vaginal gel in patients suffering from candidial vaginitis. Patients were divided into two groups; Group I received tioconazole vaginal gel as topical single dose therapy administered by the treating doctor and Group II received clotrimazole vaginal gel self-administered by the patient for three days. Response to therapy in both groups was studied and compared.Results: At the end of day 7, mean score of vaginal discharge quantity had a fall of 93.3% and 92.3% in tioconazole and clotrimazole group respectively but difference was statistically insignificant. Microbiological cure rate in both the groups was similar. Reduction of vaginal irritation, vaginal itching, vaginal burning, pain in the vulval area, pain during urination or during sexual intercourse, vaginal erythema, tenderness and swelling were also comparable in both the groups.Conclusions: Tioconazole gel single dose intravaginal application is as effective as clotrimazole gel three day intravaginal application. tioconazole is safe, well accepted and tolerated by the patients and will be useful in the treatment of vulvovaginal candidiasis

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Role of Color Doppler in predicting perinatal outcome in preeclampsia

Background: Preeclampsia is one of the most common complications of pregnancy, which increases both fetal and maternal mortality and morbidity. Since preeclampsia is characterized by abnormal placenta formation leading to inadequate uteroplacental blood flow, Doppler ultrasonography can prove to be a useful tool to assess fetal outcome in PIH patients. Through this study, we sought to determine the perinatal outcome on the basis of Doppler changes seen in Umbilical and Middle Cerebral artery.Methods: This was a prospective study conducted from September 2014 to August 2017 in a tertiary care hospital where 150 singleton pregnant patients with preeclampsia were examined with Doppler ultrasound of the Umbilical artery and Middle cerebral Artery. Serial Doppler examination was performed and the results of the last Doppler examination within 10 days of delivery was considered. Perinatal outcome was studied in the form of perinatal death, mean APGAR at 1 and 5 minutes, birth weight and admission to Neonatal Intensive Care Unit (NICU).Results: Abnormal Doppler velocimetry of the umbilical artery (increased resistance, AEDV, REDV) were significantly associated with poor perinatal outcome in the form of low birth weight, APGAR of ≤7 at five minutes of birth and NICU admission. However, S/D ratio of the Middle cerebral artery could not positively predict poor perinatal outcome in this study.Conclusions: Doppler technology has provided the best opportunity for repetitive non-invasive hemodynamic monitoring in human pregnancy. Umbilical artery Doppler findings are slight better predictor of adverse perinatal outcome than an abnormal MCA

Simulation of Li-ion Battery using MATLAB-Simulink for Charging and Discharging

The optimization of batteries has increased in EV and HEV applications out of which Li-ion batteries are widely used for green technology applications as an energy storage system due to its high power and energy density. In electric vehicle applications, drawbacks are observed during charging interval time on the storage system. In such situations, the multi-state charging is considered to be the ideal solution. This paper tells us about the state charging of lithium-ion battery and its criteria of charging/discharging for good battery life using MATLAB Simulink tool. The state-of-charge (SOC), measured and applied for measuring charging/discharging characteristics is an important parameter for defining the performance of a battery. Thus, accurate estimation of SOC is necessary which will protect the battery and prevent its overcharging and discharging. This will also help in improving the life span of the battery. For applications requiring higher efficiency, multi-state charging is applied

A prospective study to compare the efficacy and safety of tioconazole and clotrimazole vaginal gel in patients suffering from vulvovaginal candidiasis

Background: Vulvo vaginal candidiasis is an extremely common gynaecological condition. While clotrimazole has been the mainstay of treatment of this pathology, newer medications are now available. The study aims to compare the efficacy, compliance and safety of tioconazole single dose intravaginal gel application and clotrimazole vaginal gel for 3 days in patients suffering from vulvovaginal candidiasis.Methods: A prospective, multicentric, open label, randomized, controlled, parallel group clinical trial of 220 women with 110 in each group for the evaluation of the effects of tioconazole vaginal gel in patients suffering from candidial vaginitis. Patients were divided into two groups; Group I received tioconazole vaginal gel as topical single dose therapy administered by the treating doctor and Group II received clotrimazole vaginal gel self-administered by the patient for three days. Response to therapy in both groups was studied and compared.Results: At the end of day 7, mean score of vaginal discharge quantity had a fall of 93.3% and 92.3% in tioconazole and clotrimazole group respectively but difference was statistically insignificant. Microbiological cure rate in both the groups was similar. Reduction of vaginal irritation, vaginal itching, vaginal burning, pain in the vulval area, pain during urination or during sexual intercourse, vaginal erythema, tenderness and swelling were also comparable in both the groups.Conclusions: Tioconazole gel single dose intravaginal application is as effective as clotrimazole gel three day intravaginal application. tioconazole is safe, well accepted and tolerated by the patients and will be useful in the treatment of vulvovaginal candidiasis