Partogram and its relevance in modern obstetrics

Background: Normal labor and childbirth is fraught with complexities. In the modern times the child birth has proven to be more challenging than ever. Partogram has proven to be a simple and useful tool in monitoring normal labor. The objective of this endeavor was to site our experiences in using partogram for ‘plotting’ labors, to assess its utility, limitations and cite controversies.Methods: Authors analyzed progress of labor plotted on partograms in parturient women to see whether their labor patterns conform to the standard partogram, and can logical conclusions be drawn from their use to decide partogram’s utility and applicability.Results: The use of partogram was not universal and its charting inadequate due to lack of motivation on part of labor room residents, busy labor rooms. When plotted meticulously they showed a wide variation, and many women did not conform to the rates of dilatation of the graph. The use of partogram did not alter the rate of cesarean section for non-progressive labors with use and non-use of partogram.Conclusions: Philpott’s partogram is a very visual and useful tool to monitor labours and detect labour abnormalities timely. Although it has served as a labour management tool across the labour rooms its use is not universal. There is a plethora of conflicting opinions regarding its utility in modern obstetrics today, ranging from a complete faith in the tool to finding it obsolete and in need of a revision to calling it a medicalization of a natural process

Analysis of labor induction in a tertiary care hospital

Background: Induction of labour (IOL) is a very common labour room procedure. Although labor is a natural physiological process, deliberate intervention in the form of induction may be required in many instances. It is needed in almost 20% of pregnant women for a variety of indications. The objective is to evaluate indications, different methods, and feto-maternal outcome of induced labour in tertiary care hospital.Methods: This was a retrospective study of IOL conducted in the department of obstetrics and gynecology, Shri Guru Ram Rai institute of medical and health sciences, Dehradun, Uttarakhand. Women who underwent IOL beyond 28 weeks gestation with single cephalic presentation with no contraindication for vaginal birth were included in the study. Statistical analysis was done with Microsoft excel.Results: A total of 1532 women delivered in the hospital during the study period. Among them, 498 women were induced (32.5%). Most common method of induction was misoprostol (40.36%) followed by prostaglandin E2 gel (26.90%).  Out of 498 inductions, 377 women delivered vaginally making success of induction around 75.70%. Among them, 335 women had normal delivery (67.26%) and 42 women required instrumental delivery (8.4%) and 121 women underwent lower segment caesarean section (LSCS) (24.29%).Conclusions: Elective inductions of labor in properly selected indications at optimized timings aid in achieving a favorable maternal and fetal outcome. Methods of inductions, timing and intrapartum monitoring plays an important role in influencing obstetric outcome

Analysis of drug promotional literature and its abidance to WHO guidelines

Background: Drug promotional literature (DPL) is used by the pharmaceutical companies for promotion of their drug. It is the commonest source for providing information about the drug to the physician. According to WHO promotional literature should be reliable, truthful, informative, balanced and up to date.Methods: Study was conducted in Department of Pharmacology, Muzaffarnagar Medical College. 200 drug promotional literatures like advertisements published in medical journal, package insert of medicinal products and brochures were collected and analysed according to WHO criteria.Results: Total 200 promotional literatures were analysed. 100 promotional literatures were from the medical journal, 50 were package inserts of medicinal products and 50 were medicinal brochures. On assessing DPL using WHO criteria, all DPL mentioned brand names and dosage form (100%). Most of them published the generic name (98.5%), therapeutic uses (78%), side- effects (75%), dosage regimen (70%), contraindication (62.5%), warnings (55%), drug interaction (54%), precaution (50%), reference to scientific literature (45%), name of manufacture and distributor (99%), address of manufacturer and distributor (50%). Out of 200 DPL only 151 DPL contain references to scientific literature, 88 DPL references were retrievable and 63 were non retrievable.Conclusions: Our study shows although pharmaceutical companies are trying to adhere to the WHO criteria it is not fulfilled. As DPL are an important source of seeking information by the medical practitioner who rely on them to impart treatment to the patient, strict steps to regulate fulfilment of the WHO criteria should be taken by the government and authorities

The menace of caesarean scar pregnancy: a management challenge in modern obstetrics

Background: With the increasing caesarean section rates a new challenging evil of caesarean scar pregnancy (CSPs) has emerged. As a variant of ectopic pregnancy caesarean scar pregnancy is the rarest of all. Diagnosis and management of CSP can be challenging especially when there are no early symptoms and even lessor index of suspicion.  Objective of this endeavour was to present one institute experience of management of caesarean scar pregnancies.Methods: This are a retrospective analysis of women admitted with CSP. Detailed history, investigation, management protocols and complications were noted.Results: Of the total cases maximum women (60%) had history of previous two caesarean section. 90 % of cases were managed successfully with intra-sac or systemic methotrexate, and surgical evacuation with Foley’s catheter tamponade, only two women needed hysterectomy for uncontrolled bleeding.Conclusions: Caesarean scar pregnancy is a diagnostic and management challenge in modern obstetrics. Early ultrasound diagnosis helps in planning a successful medical treatment and serves to preserve uterus and fertility. Treatment with transabdominal intra-sac methotrexate and Foley’s catheter for tamponade is safe and effective method of treating CSPs

A prospective study to compare the efficacy of tacrolimus vs cyclosporine in vernal keratoconjunctivitis in children in India

Background: Vernal keratoconjunctivitis (VKC) is a chronic allergic conjunctival disease. Immunomodulatory drugs like cyclosporine is being used for its treatment. Tacrolimus is another immunomodulator drug that can be used in VKC. This study was done to compare the efficacy of tacrolimus and cyclosporine in VKC.Methods: This prospective study was conducted on 60 patients of either sex by dividing them into two groups. The first group was treated with cyclosporine (0.05%) ophthalmic eye drop and second group with tacrolimus (0.03%) ophthalmic ointment. Total five objective signs (hyperaemia, oedema, papillae, corneal involvement and tantra’s dot) and five subjective symptoms (itching, tearing, foreign body sensation, discharge and photophobia) data was collected and tabulated for statistical analysis.Results: Authors found TSSS in both groups decrease significantly (p <0.05 or p <0.01 or p <0.001) at all post periods as compared to respective predecessor periods except 4 weeks to 6 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Similarly, for each period, on comparing the mean TSSS between the groups TSSS between the groups at all periods does not differed statistically though at final evaluation (mean change from baseline to 8 weeks), it improved 5.2% more in tacrolimus group (83.7%) than cyclosporine group (78.5%). Similarly, TOSS also decreased at all post periods except 4 weeks to 6 weeks, and 6 weeks to 8 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Improvement in scores was 11.6% more in tacrolimus (81.6%) than cyclosporine (70.0%). Cyclosporine eye drops are associated with burning sensation and redness of eyes while transient ocular irritation was only observed side effect with tacrolimus.Conclusions: The study found tacrolimus is clinically better drug for treatment of vernal keratoconjunctivitis than cyclosporine and is also cost effective

Ultrasonographic evaluation of first trimester bleeding per vaginum

Background: First trimester is a very crucial period of pregnancy having high risks of pregnancy losses. The objective of this study was to assess the accuracy of ultrasound in diagnosis of cause of first trimester bleeding per vaginum.Methods: 200 women who attended the out-patient department with the complaint of bleeding per vagina in the first trimester pregnancy were taken for the study. Clinical assessment by pelvic examination was done and a provisional diagnosis was made. All necessary routine investigations were done followed by ultrasonographic scan of each patient. All the data was recorded in a proforma.Results: Among these 200 cases, threatened abortion in 72 cases. It was the commonest cause for bleeding. There were 20 cases of ectopic pregnancy out of which 16 were correctly diagnosed. There were 16 cases of missed abortion. There were 8 cases of hydatidi form mole. There were 40 cases of incomplete abortion, 16 cases of inevitable abortion, 8 cases of an embryonic gestation and 20 cases of complete abortion. By this study it is concluded that the accuracy of USG in diagnosing the cause of first trimester bleeding per vaginum is 96%.Conclusions: Use of USG in diagnosis of cause of bleeding in first trimester can lead to accurate and early diagnosis and save the patients from unneeded interventions based on history and clinical examination

RNA Interference and CRISPR/Cas Gene Editing for Crop Improvement: Paradigm Shift towards Sustainable Agriculture

With the rapid population growth, there is an urgent need for innovative crop improvement approaches to meet the increasing demand for food. Classical crop improvement approaches involve, however, a backbreaking process that cannot equipoise with increasing crop demand. RNA-based approaches i.e., RNAi-mediated gene regulation and the site-specific nuclease-based CRISPR/Cas9 system for gene editing has made advances in the efficient targeted modification in many crops for the higher yield and resistance to diseases and different stresses. In functional genomics, RNA interference (RNAi) is a propitious gene regulatory approach that plays a significant role in crop improvement by permitting the downregulation of gene expression by small molecules of interfering RNA without affecting the expression of other genes. Gene editing technologies viz. the clustered regularly interspaced short palindromic repeat (CRISPR)/CRISPR-associated protein (CRISPR/Cas) have appeared prominently as a powerful tool for precise targeted modification of nearly all crops’ genome sequences to generate variation and accelerate breeding efforts. In this regard, the review highlights the diverse roles and applications of RNAi and CRISPR/Cas9 system as powerful technologies to improve agronomically important plants to enhance crop yields and increase tolerance to environmental stress (biotic or abiotic). Ultimately, these technologies can prove to be important in view of global food security and sustainable agriculture

A comparative analysis of transpiration response to atmospheric increasing vapor pressure deficit conditions in cereal crops

Plant adaptation to drought depends on both inherited and adaptive characteristic of water conservative traits. Expression of limited transpiration rate (TR) under high vapor pressure deficit (VPD) conditions could be one of the potential sources of soil water conservation for drought tolerance. Large genetic variation for limited TR has been identified in the comparison of three major C4cereals viz.,maize, pearl millet and sorghum under elevating VPD. The total amount of water transpired under elevating VPD by these three cereals not found dependent on leaf area, in fact, it was reflected more by the variation in transpiration rate. Pearl millet showed better adaptation of limitation of TR than maize and sorghum under high VPD regimes

Epidemiology and Clinicopathological Profile of Renal Cell Carcinoma: A Review from Tertiary Care Referral Centre

Renal cell carcinoma (RCC) accounts for 3% of all adult cancers and 85% of all kidney tumours. Incidence of RCC is lower in Asian region, particularly in India, probably due to lack of reporting. Most of the data about RCC are from Western countries; and data from India are scarce, especially regarding para-neoplastic syndromes. We sought to determine the epidemiology, clinicopathological profile and management of RCCin a tertiary care centre in Western India. This was a retrospective study that involved data analysis of records of RCC patients who presented to our institution from April 2016 to February 2020. Laboratory investigations, including tests for paraneoplastic syndrome (PNS), and relevant radiologic investigations were performed and treatment was offered according to the stage, patient factors and available modalities. A total 142 RCC patients were included in the study. The median age of presentation was 58 years. Most of the patients (67%) were symptomatic, and 33% of the patients were asymptomatic, and the RCC was diagnosed incidentally. A large number of patients (56.3%) had PNS. The most common histopathologic type of RCC was clear cell carcinoma (68.8%), followed by papillary (20%) and chromophobe (8%) carcinoma. 40% of carcinomas with sarcomatoid differentiation were seen in patients under 50 years of age. Two cases of multicystic RCC were both seen in patients less than 50 years of age. 65.5% of the patients presented at Stage 1 and 2. Most surgeries (71.2%) were done in a minimally invasive manner. A significant number of patients were asymptomatic, in which RCC was detected incidentally. The age of presentation was earlier, yet the patients had a higher tumour stage. More than half of the patients had PNSs. Despite growing trend towards Western data, the significantly higher number of patients with PNSs and early age of presentation suggest inherent differences in tumour biology, possibly related to differences in genetic and environmental factors

Barium ferrite decorated reduced graphene oxide nanocomposite for effective electromagnetic interference shielding

There is an increased interest in the development of high performance microwave shielding materials against electromagnetic pollution in recent years. Barium ferrite decorated reduced graphene oxide (BaFe12O19@RGO) nanocomposite was synthesized by a high energy ball milling technique and its electromagnetic properties were investigated in the frequency range of 12.4-18 GHz (Ku band). The results showed that barium ferrite (BaFe12O19) nanoparticles with an average particle size of 20-30 nm were well distributed and firmly anchored onto the surface of the reduced graphene oxide sheets. The obtained nanocomposite exhibited a saturation magnetization of 18.1 emu g(-1) at room temperature. The presence of BaFe12O19 nanoparticles in the nanocomposite enhances the space charge polarization, natural resonance, multiple scattering and the effective anisotropy energy leading to a high electromagnetic interference shielding effectiveness of 32 dB (similar to 99.9% attenuation) at a critical thickness of 3 mm. The results suggested that the as-prepared BaFe12O19@RGO nanocomposite showed great potential as an effective candidate for a new type of microwave absorbing material