The Conundrums of Emerging Virtuous War

After assuming office as President, Donald Trump on the third day authorized drones strikes in Yemen. Consequently, as per U.S. Central Command (CENTCOM), five suspected member of al Qaeda were killed in central Yemen. Recently U.S. drone strikes killed two more suspected members in Abyan and other two provinces of Southern Yemen. As per, Pentagon “somewhere over 30 strikes” were carried out against al Qaeda in the Arabian Peninsula (AQAP) in two days. With the escalation of conflict in Yemen, drone strikes are likely to soar under Trump. Does this imply that Trump is following the footsteps of Obama in regard to US policy on drones and their utility in military operations

A study of caesarean sections in referred cases

Background: Referral is a coordinated movement of healthcare seekers through the health system to reach a high level of care in a small and often fatal window of time. Even physiological processes like pregnancy and childbirth are not free of complications. The purpose of this study is to understand maternal and foetal outcome in caesarean sections in referred cases.Methods: A prospective study was carried out in the OBGY department of SMT.SCL HOSPITAL, NHL Municipal medical college from April 2020 to April 2021. All referred antenatal and intranatal patients to our tertiary care centre with >20 weeks of gestation who underwent caesarean section with referral note.Results: A total 64% patients were referred from community health center. 63.5% patients were referred due to lack of high-risk management services. 211 patients underwent caesarean section while 69 patients had normal vaginal delivery. Difficulty in delivery of the baby was encountered in 53% of cases due to deep engagement of the fetal head. Major cause of admission in NICU was sepsis (38.6%) followed by prematurity (23.8%).Conclusions: Cesarean section is one of the quickest and most efficient method in the delivery of the baby and thus should in considered in patients in critical situations .The millennium development goals defined by united nation includes one goal (MDG 5) towards improving maternal health which still remains a challenge. Thus, improving knowledge of women regarding good antenatal care and strengthening referral services will play a big role in this

Pathophysiology of altered color perception

Human beings are able to perceive hundreds of shades of color which depends on the three types of cone system and various ratios of stimulation in response to different wavelengths. Perceptually and cognitively, men and women may experience appearance of color differently. The convention seems to be that women tend to prefer brighter and gratifying colors and men are more comfortable with stifled and soft colors. The reason may be linked to hormonal, developmental and environmental differences amongst both the sexes. The present review discusses various types of clinical and experimental studies done on alteration in color perception

A study of feto maternal outcome in primary caesarean section

Background: Primary caesarean section is defined as caesarean section to be performed in women who have not had previous caesarean delivery. The increase in the rates of primary caesarean section is not only due to increased caesarean section in nulligravida but also due to upward rise in caesarean section rates in parous women. Through this study we aimed to examine the frequency and the indications of primary caesarean section in nulliparous and multiparous women.Methods: A prospective study was carried out in the OBGY department of smt. SCL Hospital, NHL municipal medical college from April 2020 to April 2021. All multiparous women with previous normal vaginal delivery who underwent caesarean section this time were included in this study. Patients with previous caesarean section <28 weeks of gestation, patients who did not give consent were excluded from the study.Results: 92% were 20-30 years and are gravida 2 or 3 patients. 85% patients were booked patients. Most common indication of primary caesarean section in parous women was MSL+FD (31%). Difficulty in delivery of the baby was encountered in 45% of cases. Major cause of admission in NICU was MAS.Conclusions: Primary caesarean section has become a major driver of overall caesarean section rate. Decision making on primary caesarean section should be carefully scrutinized, introducing a diagnostic second opinion for all primary caesarean section. Primary caesarean section in both multigravida and primigravida becomes mandatory in many cases to prevent maternal and feta morbidity

Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys

Background: Pathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs) from ten low-income and middle-income countries to benchmark diagnostic availability. Methods: Diagnostic availabilities were determined for Bangladesh, Haiti, Malawi, Namibia, Nepal, Kenya, Rwanda, Senegal, Tanzania, and Uganda, with multiple timepoints for Haiti, Kenya, Senegal, and Tanzania. A smaller set of diagnostics were included in the analysis for primary care facilities compared with those expected at hospitals, with 16 evaluated in total. Surveys spanned 2004–18, including 8512 surveyed facilities. Country-specific facility types were mapped to basic primary care, advanced primary care, or hospital tiers. We calculated percentages of facilities offering each diagnostic, accounting for facility weights, stratifying by tier, and for some analyses, region. The tier-level estimate of diagnostic availability was defined as the median of all diagnostic-specific availabilities at each tier, and country-level estimates were the median of all diagnostic-specific availabilities of each of the tiers. Associations of country-level diagnostic availability with country income as well as (within-country) region-level availability with region-specific population densities were determined by multivariable linear regression, controlling for appropriate covariates including tier. Findings: Median availability of diagnostics was 19·1% in basic primary care facilities, 49·2% in advanced primary care facilities, and 68·4% in hospitals. Availability varied considerably between diagnostics, ranging from 1·2% (ultrasound) to 76·7% (malaria) in primary care (basic and advanced) and from 6·1% (CT scan) to 91·6% (malaria) in hospitals. Availability also varied between countries, from 14·9% (Bangladesh) to 89·6% (Namibia). Availability correlated positively with log(income) at both primary care tiers but not the hospital tier, and positively with regionspecific population density at the basic primary care tier only. Interpretation: Major gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities. These results can serve as a benchmark to gauge progress towards implementing guidelines such as the WHO Essential Diagnostics List and Priority Medical Devices initiatives

Application of Ketamine in Current Practice of Anesthesiology

Ketamine was discovered in 1964 by merging a ketone with an amine. Patients described feeling disconnected like they were floating in outer. Thus, it was characterized as a dissociative anesthetic. It is a unique drug that expresses hypnotic, analgesic, and amnesic effects. No other drug used in clinical practice produces these three important effects at the same time. Its newly found neuroprotective, anti-inflammatory, antitumor effects and low dose applications have helped to widen the clinical profile of ketamine. Ketamine as an analgesic adjunct in chronic pain patients is currently being researched. Combined use of ketamine and an opiate analgesic has been found to provide good perioperative pain control with reduction in symptoms such as nausea and vomiting, sedation, and respiratory insufficiency

Management Of Bilateral Temporomandibular Joint Ankylosis With Micrognathia And Obstructive Sleep Apnea Syndrome Using Interpositional Arthroplasty And Distraction Osteogenesis – A Case Report

Temporomandibular joint (TMJ) Ankylosis posses many problems like inability to open the mouth, poor oral hygiene, difficulty in eating proper food, unaesthetic appearance due to growth retardation and in severe cases difficulty in breathing specially during night depending on the time of occurance of injury. If the TMJ Ankylosis occurs the early stage of life it affects both the form and function of the patient. One of the most common treatments used to treat temporomandibular joint (TMJ) ankylosis is interpositional arthroplasty (IPA). When patients come with severe mandibular dysplasia either orthognathic surgery or distraction osteogenesis (DO) can be considered. Simultaneous IPA with DO has been used by many surgeons correct TMJ ankylosis associated with facial asymmetry/micrognathia as as it enables them to simultaneously reconstruct the neocondyle and correct facial malformations eliminating the need for second surgery. Here we have narrated a case of an young male patient suffering from bilateral TMJ Ankylosis with micrognathia treated by simultaneous IPA and DO and regular follow up was done.   &nbsp

Actinomycetes as An Environmental Scrubber

Biotechnological tools engaged in the bioremediation process are in reality, sophisticated and dynamic in character. For specialized reasons, a broad variety of such devices are employed to produce a safe and balanced environment free of all types of toxins and so make life simpler for humans on planet Earth. Actinomycetes is one of these extremely important and functionally helpful groups. They can be used for a variety of bioremediation objectives, including biotransformation, biodegradation, and many more. Actinomycetes are one of the most varied groups of filamentous bacteria, capable of prospering in a variety of ecological settings because to their bioactive capabilities. They’re famous for their metabolic diversity, which includes the synthesis of commercially useful primary and secondary metabolites. They produce a range of enzymes capable of totally destroying all of the constituents. They are well-known for their ability to produce bioactive secondary metabolites. Members of various genera of Actinomycetes show promise for application in the bioconversion of underutilized urban and agricultural waste into high-value chemical compounds. The most potential source is a wide range of important enzymes, some of which are synthesized on an industrial scale, but there are many more that have yet to be discovered. Bioremediation methods, which use naturally existing microbes to clear residues and contaminated regions of dangerous organic chemicals, are improving all the time. In the realm of biotechnological science, the potential of actinomycetes for bioremediation and the synthesis of secondary metabolites has opened up intriguing prospects for a sustainable environment

Differential Regulation of Syngap1 Translation by FMRP Modulates eEF2 Mediated Response on NMDAR Activity

SYNGAP1, a Synaptic Ras-GTPase activating protein, regulates synapse maturation during a critical developmental window. Heterozygous mutation in SYNGAP1 (SYNGAP1-/+) has been shown to cause Intellectual Disability (ID) in children. Recent studies have provided evidence for altered neuronal protein synthesis in a mouse model of Syngap1-/+. However, the molecular mechanism behind the same is unclear. Here, we report the reduced expression of a known translation regulator, FMRP, during a specific developmental period in Syngap1-/+ mice. Our results demonstrate that FMRP interacts with and regulates the translation of Syngap1 mRNA. We further show reduced Fmr1 translation leads to decreased FMRP level during development in Syngap1-/+ which results in an increase in Syngap1 translation. These developmental changes are reflected in the altered response of eEF2 phosphorylation downstream of NMDA Receptor (NMDAR)-mediated signaling. In this study, we propose a cross-talk between FMRP and SYNGAP1 mediated signaling which can also explain the compensatory effect of impaired signaling observed in Syngap1-/+ mice

St. Jude Medical: Enhanced MICS (eMICS)

Heart disease is one of the most prevalent diseases in the world. The survival chances for patients with ventricular fibrillation/ventricular tachycardia reduces significantly as time passes without treatment and even after getting timely treatment recurring episode are common. These patients can benefit from an Implantable Cardioverter Defibrillator (ICD) which can monitor heart rhythm and provide immediate treatment. Due to the ever changing physical conditions and disease progression, the ICD needs to collect diagnostic data as well as support programming by the physician. The ICD uses inductive telemetry and radio-frequency telemetry for the communication with the external devices such as a programmer or a monitor. Inductive telemetry uses less energy than RF telemetry but has a very short range of communication. In addition to inductive telemetry, the St. Jude Medical ICD supports 2.45 GHz band based asynchronized wakeup and 400 MHz MICS band based synchronized wakeup. The 2.45 GHz band based wakeup has limited wakeup range and the 400 MHz MICS based synchronized wakeup has limited availability for connection because it requires synchronization with the base station. The enhanced Medical Implant Communications Service (eMICS) algorithm is a firmware based algorithm which addresses the issues with other two wakeup schemes and provides fast, robust, and seamless wakeup. This thesis describes the design, implementation, and initial testing of eMICS algorithm on the Unity device platform in Technology Project Management (TPM) phase. The eMICS automated test tool developed at St. Jude Medical was used to test the eMICS algorithm under a controlled lab environment, typical home environment, typical hospital/clinic environment, and in the field. The project was successfully completed and transferred to Product Project Management (PPM) phase. However, the suggested duration of 60-90 seconds for sniff interval which will cause the least effect on the battery life was found unacceptable, and there is also a strong need for energy efficient hardware which draws minimal amount of current during each sniff. Therefore, St. Jude Medical is collaborating with the hardware vender to implement eMICS algorithm in the next version of hardware