Interesting rare case of recurrent puerperal uterine inversion: a case report

Uterine inversion is a rare obstetric emergency that may lead to severe haemorrhage, shock and eventually death. The incidence of uterine inversion varies from one in 2,000-20,000 deliveries. Recurrent uterine inversion is still rare with no exact reported incidence so far. We report a case of a near miss patient, 28 years old primiparous with complete uterine inversion with atonic postpartum haemorrhage and shock, managed by manual repositioning and tamponade insertion which got corrected. Patient had recurrent uterine inversion twice in the puerperal period on 5th and 7th postpartum day. A new approach to management was taken. Rather than going for laparotomy, vaginal manual correction followed by intrauterine tri-way foley catheter insertion was done. Gradual deflation was done leading to final permanent correction. Uterine inversion is a rare but potentially deadly complication post vaginal delivery. Mortality and morbidity can be reduced by rapid recognition and immediate replacement. For recurrent inversion prolonged intrauterine balloon placement may be needed in rare cases

Synthesis of Al and Ag nanoparticles through ultra-sonic dissociation of thermal evaporation deposited thin films for promising clinical applications as polymer nanocomposite

Nanoparticles (NPs) having well-defined shape, size and clean surface serve as ideal model system to investigate surface/interfacial reactions. Ag and Al NPs are receiving great interest due to their wide applications in bio-medical field, aerospace and space technology as combustible additives in propellants and hydrogen generation. Hence, in this study, we have synthesized Ag and Al NPs using an innovative approach of ultra-sonic dissociation of thin films. Phase and particle size distributions of the Ag and Al NPs have been determined by X-ray diffraction (XRD) and transmission electron microscopy (TEM). Thin film dissociation/dissolution mechanism, hence conversion into NPs has been characterized by SEM- scanning electron microscope. EDXA & ICPMS have been performed for chemical analysis of NPs. Optical properties have been characterized by UV-Vis and PL spectroscopy. These NPs have also been investigated for their anti-bacterial activity against Escherichia coli bacteria. To the best of our knowledge, this is the first time when NPs has been synthesized by ultra-sonic dissociation of thin films. As an application, these NPs were used further for synthesis of nanocomposite polymer membranes, which show excellent activity against bio film formation

A histopathological study of hysterectomy specimens and their clinical correlation in patients at tertiary health care setup in Bundelkhand region of Uttar Pradesh

Background: Women in their life time are prone to develop several neoplastic and non-neoplastic lesions in her uterus and cervix basically due to hormone responsiveness of female genital tract system. The aim of the study was to evaluate all hysterectomy specimens and to study the pattern of pathological changes of different lesions occurring in cervix and uterus associated with different age groups. Methods: This retrospective cross-sectional, study was conducted on patients undergoing hysterectomy in department of obstetrics and gynecology in MLB Medical College Jhansi and hysterectomized specimens reported to department of pathology for further evaluation. Total 35 hysterectomy specimens were included in the study with age of patients varying from 30 years to 60 years. Detailed clinical and other relevant history were taken followed by thorough gross examination and histopathological evaluation. Results: Majority of hysterectomy specimens were sent for histopathological examination in the department of pathology, out of these 30 (85%) were total abdominal hysterectomy specimen, 5 (14.28%) were of vaginal hysterectomy specimens. Out of all these cases, in 7 (20%) cases bilateral or unilateral salpingopherectomy done. Conclusions: In our study, most common surgical procedure for hysterectomy was abdominal hysterectomy 30 (85.7%) followed vaginal hysterectomy 5 (14.28%) All the vaginal hysterectomy was done for second- and third-degree utero-vaginal prolapse. Most prevalent endometrial histopathological finding in our study is non-secretive 15 (42.8%), secretive 7 (20%) followed by atrophic 6 (17.1%) as most of the patients in our study presents with abnormal uterine bleeding and menorrhagia 23 (65.7%)

A comparative study of the technical feasibility of complete salpingectomy versus tubal ligation as a method of tubal sterilisation during caesarean delivery

Background: Recent theory on ovarian malignancy suggests its origin from primary foci in fallopian tubes. Prophylactic salpingectomy may benefit in risk reduction of ovarian cancer. The aim of the study was to compare the feasibility of complete salpingectomy with bilateral tubal ligation was made during caesarean delivery in women desirous of permanent sterilisation.Methods: We conducted a prospective interventional randomized control study in department of obstetrics and gynaecology, ESI-PGIMSR Basaidarapur, New Delhi from October 2018 to February 2021. 70 women participated in this study desiring permanent sterilisation during caesarean delivery. Patients were randomized into two groups who either underwent bilateral tubal ligation [group A (N=35)] or complete bilateral salpingectomy [group B (N=35)].Results: Procedure was completed in 91% patients in group A and 77% in group B (p >0.05) making both the procedures feasible.  Total operative time (min) in group A and B were 47 and 55 respectively (p<0.01). Mean sterilisation procedure time (min) in group A was 5 and group B was 6 (p=0.13). No significant difference was seen in intra-operative blood loss (400 ml in group A vs 300 ml in group B), percentage decrease in post-op haemoglobin (g/dl) (4.56±2.96 in group A vs 3.91±2.7 in group B), post-operative serum Anti-mullerian hormone (AMH) levels (ng/ml) (group A-0.965±0.12 vs 0.7±0.09 in group B) in the two groups.Conclusions: Salpingectomy as an alternative to tubal ligation should be discussed with suitable patients desirous of permanent sterilisation during caesarean delivery.

Understanding the Role of Online Support to Tourist Spots in India

The online travel agencies or popularly known as OTAs have become one of the most reliable options for the travellers to make their arrangements. The number of players both across the world and in India have seen a rise and the same has quite successfully helped in planning trips for many tourists. The study here is curious to understand the role of these OTAs in the process of resuming the tourist destination especially in India. The situation in India with respect to the use of OTAs is quite different as the country is an emerging one and there are issues of digital divide still persistent in the economy The study here collected 238 primary responses from tourist across the country to identify their perception about the online travel agencies and recognise the factors that cause an impact in the adoption process. The study has used a number of advanced statistical methods such as principal component analyses and multiple linear regression to establish the factors as well as the relationship with the adoption process. The regression model being formulated is able to estimate of variance of 14% on the intention of using online modes to put the two responses in India by highlighting the two main factors causing an impact on it. The perceived ease of use and the information transparency are the main reasons why a tourist based in India prefers to book their destination requirements using online travel agencies

Virtual Voting System

India's voting system plays an important role in Indian Democracy. The existing system is offline and has certain weaknesses. In recent years, the spread of covid19, inefficient rural voters, people far from their place of birth, paper waste affecting nature, budgets that should be used for development, invisible fraud, waste of human labor, have been recorded and can be avoided by the virtual voting system. The research aims to supply an easy and secure electoral system in India. The method used descriptive qualitative. The results indicate that a virtual voting system is environmentally friendly and is considered a resource-saving way for the election. It is because minimizes errors and increases voter participation through convenient virtual voting. In conclusion, a virtual voting system can develop anAadhar based advanced Electronic Voting Machine (EVM), which helps in a free and fair way of conducting election

Comparison of antral follicle count, antimullerian hormone and day 2 follicle stimulating hormone as predictor of ovarian response and clinical pregnancy rate in patient with an abnormal ovarian reserve test

Background: Patients having abnormal ovarian reserve test are likely to have poor response to controlled ovarian stimulation (COS) in artificial reproduction technique, where large number of follicles is desirable. Although direct measurement of the primordial follicle pool is impossible, it has been shown that the number of antral follicles in the ovaries is proportionally related to the size of primordial follicle stock from which they were recruited. Therefore, the antral follicle count (AFC) is believed to represent the quantitative aspect of ovarian aging. The aim of the study was to To compare the  day two Antral follicle count, antimullerian hormone and  Follicle stimulating hormone levels as a predictor of ovarian response among the patients undergoing controlled ovarian stimulation using GnRH antagonist and its implications in clinical pregnancy rate.Methods: A prospective study was conducted in KJK Hospital Trivandrum on 119 patients having abnormal ovarian reserve test undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol from January 2010- December 2015. Patients AFC, AMH and FSH levels were measured and their association in predicting the ovarian reserve in terms of oocyte maturation, fertilization and embryo cleavage and their pregnancy rate.Results: AFC had the highest accuracy for predicting ovarian response in patient with abnormal ovarian reserve test and was statistically significant (number of oocyte aspirated p value <0.001) than AMH (p value 0.06) and FSH (p value 0.212) in predicting ovarian response. For prediction of poor ovarian response a model including AFC+AMH was found to be almost similar to that of (p value 0.001) using AFC alone. However AFC (p value 0.458), AMH (p value 0.267) and FSH (p value 0.486) did not predict pregnancy rate in patient with abnormal ovarian reserve test and it was statistically not significant.Conclusions: This study indicates that AFC is the most useful marker in predicting the ovarian response. Doing AFC assessment alone would be more cost effective for predicting the ovarian response in patients undergoing controlled ovarian stimulation with GnRH antagonist

Machining Characteristics and Parametric Optimisation of Inconel 825 during Electric Discharge Machining

This paper presents the machining characteristics and parametric optimisation of Inconel 825 during die-sinking electrical discharge machining (EDM) process. This work considers seven input parameters out of which six are of three levels and one is of one level. Metal removal rate (MRR), tool wear rate (TWR) and surface roughness (SR) have been considered as performance measures. Before carrying out physical experimental runs, the experiments have been designed using Taguchi’s L36 (21 × 36) orthogonal array (OA). In order to identify the significant input parameters, Analysis of Variance has been employed on the experimental data. Discharge current, pulse-on-time, tool material and tool electrode lift time are found as significant input parameters. The effects of these significant parameters on the performance measures have been presented using Taguchi\u27s technique. After machining, study of surface characteristics of the electric discharged machined surface has been carried out using scanning electron microscopy (SEM), energy dispersive x-ray spectroscopy (EDXS) and X-ray diffraction (XRD). These studies help in obtaining the information pertaining to topography of the machined surface, material transfer from tool and dielectric to the machined surface, and presence of extra element and their different phases at the machined surface. It has been found from the research that Carbon, Oxygen, Iron, Nickel, Chromium and little amount of Molybdenum are transferred to the surface of work piece. Further, for the best yield of the process, the optimal combination of input parameters has been obtained and reported using Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) as a multi-objective optimisation technique. Consideration of two different dielectric fluids and three different electrode materials is the novelty of the work

Predicting risk and prognosis of preeclampsia by evaluating platelet indices

Background: Preeclampsia is an obstetric disorder affecting 2-8% pregnancies globally and 8-10% pregnancies in India. The study was conducted to evaluate platelet count, mean platelet volume and platelet distribution width as potential predictor of preeclampsia. It also aimed to see if these platelet indices have a prognostic significance in determining the preeclampsia severity.Methods: A prospective study was conducted on 120 pregnant women at 20 to 24 weeks of gestation with singleton pregnancy. At monthly intervals CBC (complete blood count) was done from 20 to 24 weeks till delivery and 7 days after delivery. Data with increasing gestation were collected, analysed and expressed as mean, standard deviations and correlation coefficients.Results: We observed significant decrease in PC and increase in MPV and PDW in patients with preeclampsia compared to normotensive patients. We also observed that it was more significant in severe preeclampsia than non-severe preeclampsia. The r value of PC for normotensive, non-severe and severe preeclampsia was -0.58, -0.59 and -0.94 respectively. The r value of MPV for normotensive, non-severe and severe preeclampsia was 0.89, 0.97 and 0.98 respectively. The r value of PDW for normotensive, non-severe and severe preeclampsia was 0.98, 0.98 and 0.99 respectively.Conclusions: Patients with preeclampsia are more likely to have changes in PC, MPV and PDW, which can be observed in early pregnancy. Thus, estimation of PC, MPV and PDW can be considered as an early, simple and cost-effective procedure in the estimating the severity of preeclampsi