The study of causes, mode of delivery in intrauterine fetal death and associated complications

Background: Intra uterine fetal death (IUFD) is defined as the baby born with no signs of life at or after 28 weeks of gestation. It is important to diagnose the cause in order to avoid further recurrence and to treat any maternal associated factors. The aim of the present study was to calculate incidence of IUFD in our hospital and know the causes, mode of delivery, associated complications. So we can take measures to prevent them in future.Methods: The retrospective study was conducted in the department of Obstetrics and Gynecology in Kanachur Medical College, Mangalore from January 2017 to January 2020. The women with confirmed diagnosis of IUFD on Ultrasound and beyond 28 weeks of gestation were included in the study.Results: In the study period, total 2026 patients delivered, of which 40 cases were IUFD, hence our incidence rate was 19.74 per 1000 population. 62.5% cases were multigravida. 15% had previous history of abortions while 5% previously had IUFD. In 37.5% cases, the cause was unknown, followed by 22.5% having pregnancy induced hypertension. Anemia contributed to 17.5% and placental causes in 12.5%. 10% of the women had PPH. One patient had sepsis, followed by acute renal failure and later died of multi organ failure.Conclusions: All the causes are not preventable, many of them can be identified early in pregnancy and thus IUFD can be prevented. All the high risk pregnancies should undergo antenatal fetal surveillance and should have frequent ante natal visits to reduce IUFD rates

Clinical skill learning for tomorrow’s doctors - a step towards better obstetric care

Background: Female urethral catheterization is the most commonly performed procedure in obstetrics and gynecology, for the assessment of urinary output. Many times catheterization is done by junior colleagues with improper technique resulting in improper catheterization and urethral injury. It is a must to know skill for every graduating medical student to avoid devastating consequences of performing it poorly. The objectives of this study are to evaluate the effectiveness of four step method of skill learning of bladder catheterization in female patients by interns and demonstrate the competency in the proper insertion and removal of an indwelling urinary catheter and also the study aimed to determine the effectiveness of bladder simulator training for medical interns.Methods: A prospective, observational and skill imparting study done using a specially designed model, after ethical committee approval. 30 Interns were divided in to six groups of five each for skill learning. It was done with Kirkpatrik model using specially designed objective structured clinical examination forms and scoring sheets. Sample paired t test was used.Results: 80% of the interns could perform the skill with maximum scores.Conclusions: It is an innovative teaching learning method for incoming interns which will help them to improve knowledge and practice and finally reduce the risk of complications and injury.

Identification of QTLs and candidate genes for high grain Fe and Zn concentration in sorghum [Sorghum bicolor (L.)Moench]

Sorghum is a major food crop in the semi-arid tropics of Africa and Asia. Enhancing the grain iron (Fe) and zinc (Zn) concentration in sorghum using genetic approaches would help alleviate micronutrient malnutrition in millions of poor people consuming sorghum as a staple food. To localize genomic regions associated with grain Fe and Zn, a sorghum F6 recombinant inbred line (RIL) population (342 lines derived from cross 296B PVK 801) was phenotyped in six environments, and genotyped with simple sequence repeat (SSR), DArT (Diversity Array Technology) and DArTSeq (Diversity Array Technology) markers. Highly significant genotype environment interactions were observed for both micronutrients. Grain Fe showed greater variation than Zn. A sorghum genetic map was constructed with 2088 markers (1148 DArTs, 927 DArTSeqs and 13 SSRs) covering 1355.52 cM with an average marker interval of 0.6 cM. Eleven QTLs (individual) and 3 QTLs (across) environments for Fe and Zn were identified. We identified putative candidate genes from the QTL interval of qfe7.1, qzn7.1, and qzn7.2 (across environments) located on SBI-07 involved in Fe and Zn metabolism. These were CYP71B34, and ZFP 8 (ZINC FINGER PROTEIN 8). After validation, the linked markers identified in this study can help in developing high grain Fe and Zn sorghum cultivars in sorghum improvement programs globally

Identification of QTLs and Underlying Candidate Genes Controlling Grain Fe and Zn Concentration in Sorghum [Sorghum bicolor (L).Moench]

Biofortification is one of sustainable options for combating micronutrient-malnutrition. For identifying genomic regions associated with grain Fe and Zn in sorghum, RIL population (342 individuals) from cross 296B × PVK 801 was phenotyped for two years at three locations and genotyped with SSRs and DArTs. Highly significant genotype×environment interactions were observed for both micronutrients; grain Fe showed greater variation than Zn. Sorghum genetic map was constructed with 2088 markers (1148 DArTs, 927 DArT Seqs and 13 SSRs) covering 1355.52 cM with an average marker interval of 0.6cM. A total of 18 QTLs controlling Fe and Zn were found stable across environments. Three QTLs for Fe and 15 for Zn were identified with phenotypic variance explained (PVE) values ranging from 3.94 to 5.09% and 3.17 to 9.42%, respectively. Of these 18 stable QTLs, 11 were located on chromosome SBI-07. Favorable alleles for 11 QTLs (co-located) for Fe and Zn on chromosome SBI-07 were contributed by parent PVK801-P23. QTLs were analyzed in-silico to identify underlying candidate genes, 62 candidate genes involved in Fe/Zn metabolism were identified within QTL interval; twenty-three were found in QTL with highest phenotypic effect (PVE 9.42%). Sorghum genes underlying Fe/Zn QTLs were used to analyze gene synteny with rice and maize. Synteny sequence level between sorghum-rice ranged from 44% to 97%, while sorghum-maize ranged from 49% to 99%. QTLs/candidate/novel genes along with the marker/genetic resources identified through this study can help in developing high Fe and Zn lines in cost-effective and efficient manner

Genetic Variability, Genotype × Environment Interaction, Correlation, and GGE Biplot Analysis for Grain Iron and Zinc Concentration and Other Agronomic Traits in RIL Population of Sorghum (Sorghum bicolor L. Moench)

The low grain iron and zinc densities are well documented problems in food crops, affecting crop nutritional quality especially in cereals. Sorghum is a major source of energy and micronutrients for majority of population in Africa and central India. Understanding genetic variation, genotype × environment interaction and association between these traits is critical for development of improved cultivars with high iron and zinc. A total of 336 sorghum RILs (Recombinant Inbred Lines) were evaluated for grain iron and zinc concentration along with other agronomic traits for 2 years at three locations. The results showed that large variability exists in RIL population for both micronutrients (Iron = 10.8 to 76.4 mg kg−1 and Zinc = 10.2 to 58.7 mg kg−1, across environments) and agronomic traits. Genotype × environment interaction for both micronutrients (iron and zinc) was highly significant. GGE biplots comparison for grain iron and zinc showed greater variation across environments. The results also showed that G × E was substantial for grain iron and zinc, hence wider testing needed for taking care of G × E interaction to breed micronutrient rich sorghum lines. Iron and zinc concentration showed high significant positive correlation (across environment = 0.79; p 0.60, in individual environments) for Fe and Zn and other traits studied indicating its suitability to map QTL for iron and zinc

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570