Obstetric and new born outcome in HIV infected pregnant women: a prospective cohort study in Bangalore Medical College Hospitals, India

Background: The effect of HIV on obstetric complications is known to vary across regions of world. The variation may be due to HIV infection per se or it may be due to complex interaction of related medical and social conditions that affect pregnancy. Incidence of these obstetric complications in HIV infected pregnant women is not well reported in India. So, this prospective cohort study was carried to observe the demographics and incidence of obstetrics complications like abortions, still birth, premature rupture of membranes, preterm delivery, opportunistic infections in HIV infected pregnant women.Methods: All pregnant women who were screened positive for HIV test, irrespective of their gestational age were included in the study. Apart from routine obstetric care, CD4 cell count was carried out. The patients were followed up till term, delivery and up to 6-week postpartum period. Obstetric outcomes like incidence of abortion, intrauterine death, preterm delivery and premature rupture of membrane were noted. Baby`s birth weight and the incidence of maternal opportunistic infection were noted and correlated with maternal CD4 cell count.Results: Maternal HIV infection is associated pre-term labour in 34.5%, PROM in 30%, low birth weight in 52.3%. Increased incidences of these adverse outcomes have an inverse relationship with CD4 count.Conclusions: Maternal HIV infection is associated with increased incidence of adverse obstetric outcome and opportunistic infection, and their incidences increase with lower CD4 count

Urological injuries during obstetric and gynaecological procedures: a retrospective analysis over a period of eleven years

Background: To determine frequency and nature of urological injuries in obstetric and gynaecological procedures and their consequences and mode of management in a tertiary care hospital SDM Medical college and hospital, Dharwad, India.Methods: A retrospective study of all obstetric and gynaecological surgeries over a period of 11 years from January 2004 to December 2014 was carried out at Department of Obstetrics and Gynaecology, SDM Medical College and Hospital, Dharwad, India. Cases with the documented urological injuries were analyzed further. A total of 18,250 patients underwent obstetric and gynaecological procedures like lower segment caesarean section, various types of hysterectomies were analyzed. Cases with urologic injuries were identified and analyzed for risk factor, timing of diagnosis, their management and consequences.Results: Out of 18,250 patients undergoing various surgeries, 37(0.2%) patients had bladder injury and 4(0.02%) patients had ureteric injury. In gynecologic procedures, the incidence of bladder injury was highest in radical hysterectomy (2 out of 79, 2.5%) followed by TLH/LAVH (4 out of 299, 1.3%), NDVH (7 out of 490, 1.4%) TAH (5 out of 1360, 0.37%), laparotomy (1 out of 347, 0.29%) and vaginal hysterectomy (3 out of 1529, 0.2%). Three ureteric injuries were noted in cases of TLH/LAVH (3 out of 299) and one in case of TAH (1 out of 1360, 0.07%).Conclusions: Even though urological injuries are statistically rare, they are responsible for significant morbidity. Bladder injuries are more common, but are easy to manage with earlier diagnosis. Ureteric injuries which are usually diagnosed late and hence cause more morbidity than bladder injuries

Rupture uterus: a prospective observational study of 25 consecutive cases in a tertiary referral centre in South India

Background: Uterine rupture in pregnancy is a rare though catastrophic complication with a high incidence of foetal and maternal morbidity. It appeared to be on the decline in recent times, prompting us to analyse the clinical picture now. The objective of the study was to study the risk factors, clinical profile and consequences of uterine rupture on maternal and perinatal outcome.Methods: A prospective observational study of 25 consecutive cases of uterine rupture was carried out between July 2013 and October 2015. All the cases of rupture uterus either referred or diagnosed after admission were included. Detailed demographic data, past and present obstetric events, time taken to reach the referral centre, the reasons for any delay, mode of presentation, type of rupture, management and maternal and foetal outcomes were analysed.Results: The incidence of rupture was 1 in 915 deliveries. Seventy-two per cent of them were referred cases. Average time to reach from referral centre was 4.3 hours, the common reasons for delay being patient factors (33%), transport problems (38%) and delayed referrals (22%). Previous caesarean section was the most common predisposing factor (56%). Sixty-four per cent of the ruptures were diagnosed clinically. Eighty-four per cent of the ruptures were complete. Sub-total hysterectomy was carried out in 14 (56%) patients. Internal iliac artery ligation (20%) and bladder repair (8%) were sometimes required. All women required blood transfusion.  Perinatal mortality was seen in 76%. There was no maternal mortality.Conclusions: Uterine rupture is a cause of severe acute maternal morbidity and very high perinatal mortality.  Delay in referral and diagnosis can lead to significant maternal morbidity and hysterectomy

A Singular Perturbation Analysis for \\Unstable Systems with Convective Nonlinearity

We use a singular perturbation method to study the interface dynamics of a non-conserved order parameter (NCOP) system, of the reaction-diffusion type, for the case where an external bias field or convection is present. We find that this method, developed by Kawasaki, Yalabik and Gunton for the time-dependant Ginzburg-Landau equation and used successfully on other NCOP systems, breaks down for our system when the strength of bias/convection gets large enough.Comment: 5 pages, PostScript forma

Stress-driven instability in growing multilayer films

We investigate the stress-driven morphological instability of epitaxially growing multilayer films, which are coherent and dislocation-free. We construct a direct elastic analysis, from which we determine the elastic state of the system recursively in terms of that of the old states of the buried layers. In turn, we use the result for the elastic state to derive the morphological evolution equation of surface profile to first order of perturbations, with the solution explicitly expressed by the growth conditions and material parameters of all the deposited layers. We apply these results to two kinds of multilayer structures. One is the alternating tensile/compressive multilayer structure, for which we determine the effective stability properties, including the effect of varying surface mobility in different layers, its interplay with the global misfit of the multilayer film, and the influence of asymmetric structure of compressive and tensile layers on the system stability. The nature of the asymmetry properties found in stability diagrams is in agreement with experimental observations. The other multilayer structure that we study is one composed of stacked strained/spacer layers. We also calculate the kinetic critical thickness for the onset of morphological instability and obtain its reduction and saturation as number of deposited layers increases, which is consistent with recent experimental results. Compared to the single-layer film growth, the behavior of kinetic critical thickness shows deviations for upper strained layers.Comment: 27 pages, 11 figures; Phys. Rev. B, in pres

Epitaxial growth in dislocation-free strained alloy films: Morphological and compositional instabilities

The mechanisms of stability or instability in the strained alloy film growth are of intense current interest to both theorists and experimentalists. We consider dislocation-free, coherent, growing alloy films which could exhibit a morphological instability without nucleation. We investigate such strained films by developing a nonequilibrium, continuum model and by performing a linear stability analysis. The couplings of film-substrate misfit strain, compositional stress, deposition rate, and growth temperature determine the stability of film morphology as well as the surface spinodal decomposition. We consider some realistic factors of epitaxial growth, in particular the composition dependence of elastic moduli and the coupling between top surface and underlying bulk of the film. The interplay of these factors leads to new stability results. In addition to the stability diagrams both above and below the coherent spinodal temperature, we also calculate the kinetic critical thickness for the onset of instability as well as its scaling behavior with respect to misfit strain and deposition rate. We apply our results to some real growth systems and discuss the implications related to some recent experimental observations.Comment: 26 pages, 13 eps figure

Deep phenotyping and genomic data from a nationally representative study on dementia in India

The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) is a nationally representative in-depth study of cognitive aging and dementia. We present a publicly available dataset of harmonized cognitive measures of 4,096 adults 60 years of age and older in India, collected across 18 states and union territories. Blood samples were obtained to carry out whole blood and serum-based assays. Results are included in a venous blood specimen datafile that can be linked to the Harmonized LASI-DAD dataset. A global screening array of 960 LASI-DAD respondents is also publicly available for download, in addition to neuroimaging data on 137 LASI-DAD participants. Altogether, these datasets provide comprehensive information on older adults in India that allow researchers to further understand risk factors associated with cognitive impairment and dementia.Peer reviewe

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Approximate asymptotic solutions to the d-dimensional fisher equation

We present approximate asymptotic solution to the Fisher equation in arbitrary dimensions for a broad class of initial conditions. Specifically, we consider the case of domain growth from a seed in a zero background. Our analytic solution for this case has an asymptotic velocity of 2 in all dimensions. In one dimension, our solution for this case compares well with a numerical simulations of the Fisher equation