The role of color Doppler and spectral flow analysis in the management of pregnancy induced hypertension

Background: Nearly one third intrauterine death of normally formed singleton fetuses are associated with IUGR coexisting with or without pregnancy induced hypertension (PIH). Abnormal fetal circulation is considered a major factor in fetal growth restriction, both as a cause and an indicator. Doppler ultrasound is a relatively new technique which merits investigations as a screening method for IUGR and PIH as both are associated with placental vascular pathology. The development of Doppler ultrasonographic technology, particularly during last 10 years, has provided an opportunity to obtain both qualitative and quantitative assessment of maternal and fetal hemodynamics using a non-invasive method. Objectives were to assess the role of color Doppler and spectral flow analysis in the management of pregnancy induced hypertension.Methods: It was a prospective observational study in which 50 pregnant women were taken as cases with pregnancy induced hypertension and 25 as matched controls without any high-risk factor. All patients were examined for colour Doppler spectral flow analysis. Detailed USG results in the form of maturity by biparietal diameter, head circumference, femoral length, abdominal circumference, liquor, and expected fetal weight were measured and noted. Doppler study of umbilical artery, fetal middle cerebral artery, both maternal uterine arteries and ductus venosus was carried out. Parameters in the form of resistive index (RI), pulsatility index (PI) and systolic/diastolic ratio (S/D) of all four arteries were taken. In ductus venosus waveform, changes in the ‘a’ wave were noted. All participants were followed up from the point of the recruitment up to the time of delivery. At the time of delivery, the mode of delivery, any complications, the Apgar score, weight of the baby, birth asphyxia and admission in NICU were noted.Results: The number of patients with PIH were highest in the age group of 21-25 years [n=31 (62%)]. IUGR of fetus occurred in 74% of the cases with PIH, while no any patients with IUGR fetus among the control group. 92% patients among uterine notches showed abnormal fetal outcome in the form of low birth weight, preterm delivery, LSCS for fetal distress, birth asphyxia or NICU admission of the neonate. Out of total 37 (74%) IUGR cases, 24 (65%) cases had fetoplacental Doppler abnormality. Out of total 6 cases with absent end-diastolic flow (AEDF) 4 cases had abnormal fetal outcome and 2 cases had delivered still-born babies. 20 out of 30 cases had abnormal fetal middle cerebral arterial Doppler (MCA) PI, out of which 19 patients had abnormal fetal outcome. 23 cases had abnormal CPR, out of them 20 (87%) cases had abnormal outcome and only 3 cases had normal fetal outcome. The parameters at the time of delivery are number of cases with delivery before 37 weeks of GA (63.3%), SGA babies (70%), LSCS for fetal distress (43.3%), and NICU admission (43.3%).Conclusions: Examining the maternal vessels using Doppler ultrasound, it is possible to determine the risk of complication developing in the course of pregnancy long before clinical signs of preeclampsia appear, so that therapeutic measures may be undertaken early

Case series of mucormycosis occurring in patients of COVID-19

Mucormycosis is an umbrella term used for diseases caused by many non-septate filamentous fungal species which is caused by sub-phylum Mucormycotina. It is an acute opportunistic and aggressive fulminant invasive infection that can occur in immunocompromised patients, such as uncontrolled diabetes, renal failure, organ transplant, long-term corticosteroid and immunosuppressive therapy, AIDS, malignancy and corona virus disease 2019 (COVID 19) infections. Mucormycosis is now third most common invasive mycoses after candidiasis and aspergillosis. The COVID-19 infection is characterised by wide range of disease patterns, ranging from mild to life-threatening pneumonia. Many bacterial and fungal co-infections may exist and may be associated with preexisting morbidity or may develop as a hospital-acquired infection such as ventilator-associated pneumonia. Extensive use of corticosteroids and broad-spectrum antibiotics lead to exacerbation of preexisting disease. The aim of this study is to identify the risk factors along with high index of suspicion, early diagnosis and aggressive management of mucormycosis

Processing of aluminum-graphite particulate metal matrix composites by advanced shear technology

Copyright @ 2009 ASM International. This paper was published in Journal of Materials Engineering and Performance 18(9) and is made available as an electronic reprint with the permission of ASM International. One print or electronic copy may be made for personal use only. Systematic or multiple reproduction, distribution to multiple locations via electronic or other means, duplications of any material in this paper for a fee or for commercial purposes, or modification of the content of this paper are prohibited.To extend the possibilities of using aluminum/graphite composites as structural materials, a novel process is developed. The conventional methods often produce agglomerated structures exhibiting lower strength and ductility. To overcome the cohesive force of the agglomerates, a melt conditioned high-pressure die casting (MC-HPDC) process innovatively adapts the well-established, high-shear dispersive mixing action of a twin screw mechanism. The distribution of particles and properties of composites are quantitatively evaluated. The adopted rheo process significantly improved the distribution of the reinforcement in the matrix with a strong interfacial bond between the two. A good combination of improved ultimate tensile strength (UTS) and tensile elongation (e) is obtained compared with composites produced by conventional processes.EPSR

A Mouse Model of Post-Arthroplasty Staphylococcus aureus Joint Infection to Evaluate In Vivo the Efficacy of Antimicrobial Implant Coatings

Post-arthroplasty infections represent a devastating complication of total joint replacement surgery, resulting in multiple reoperations, prolonged antibiotic use, extended disability and worse clinical outcomes. As the number of arthroplasties in the U.S. will exceed 3.8 million surgeries per year by 2030, the number of post-arthroplasty infections is projected to increase to over 266,000 infections annually. The treatment of these infections will exhaust healthcare resources and dramatically increase medical costs.To evaluate novel preventative therapeutic strategies against post-arthroplasty infections, a mouse model was developed in which a bioluminescent Staphylococcus aureus strain was inoculated into a knee joint containing an orthopaedic implant and advanced in vivo imaging was used to measure the bacterial burden in real-time. Mice inoculated with 5x10(3) and 5x10(4) CFUs developed increased bacterial counts with marked swelling of the affected leg, consistent with an acute joint infection. In contrast, mice inoculated with 5x10(2) CFUs developed a low-grade infection, resembling a more chronic infection. Ex vivo bacterial counts highly correlated with in vivo bioluminescence signals and EGFP-neutrophil fluorescence of LysEGFP mice was used to measure the infection-induced inflammation. Furthermore, biofilm formation on the implants was visualized at 7 and 14 postoperative days by variable-pressure scanning electron microscopy (VP-SEM). Using this model, a minocycline/rifampin-impregnated bioresorbable polymer implant coating was effective in reducing the infection, decreasing inflammation and preventing biofilm formation.Taken together, this mouse model may represent an alternative pre-clinical screening tool to evaluate novel in vivo therapeutic strategies before studies in larger animals and in human subjects. Furthermore, the antibiotic-polymer implant coating evaluated in this study was clinically effective, suggesting the potential for this strategy as a therapeutic intervention to combat post-arthroplasty infections

Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls

Background The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation