Effects of the WHO Labour Care Guide on cesarean section in India: a pragmatic, stepped-wedge, cluster-randomized pilot trial

Cesarean section rates worldwide are rising, driven by medically unnecessary cesarean use. The new World Health Organization Labour Care Guide (LCG) aims to improve the quality of care for women during labor and childbirth. Using the LCG might reduce overuse of cesarean; however, its effects have not been evaluated in randomized trials. We conducted a stepped-wedge, cluster-randomized pilot trial in four hospitals in India to evaluate the implementation of an LCG strategy intervention, compared with routine care. We performed this trial to pilot the intervention and obtain preliminary effectiveness data, informing future research. Eligible clusters were four hospitals with >4,000 births annually and cesarean rates ≥30%. Eligible women were those giving birth at ≥20 weeks' gestation. One hospital transitioned to intervention every 2 months, according to a random sequence. The primary outcome was the cesarean rate among women in Robson Group 1 (that is, those who were nulliparous and gave birth to a singleton, term pregnancy in cephalic presentation and in spontaneous labor). A total of 26,331 participants gave birth. A 5.5% crude absolute reduction in the primary outcome was observed (45.2% versus 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care outcomes were not significantly different, though labor augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for other health outcomes or women's birth experiences. These findings can guide future definitive effectiveness trials, particularly in settings where urgent reversal of rising cesarean section rates is needed. Clinical Trials Registry India number: CTRI/2021/01/03069

Enhanced T cell responsiveness to Mycobacterium bovis BCG r32-kDa Ag correlates with successful anti-tuberculosis treatment in humans

Th1 and Th2 cytokines play key role in protection from and pathogenesis of mycobacterial infection and their dynamic changes may predict clinical outcome of the patient. Patients with tuberculosis (TB) have a poorer cellular immune response to recombinant 32-kDa antigen (Ag) of Mycobacterium bovis (r32-kDa M. bovis) than do healthy volunteers. The basis for this observation was studied by evaluating the Th1 (gamma interferon [IFN-γ ]) produced in response to the r32-kDa Ag M. bovis by peripheral blood mononuclear cells (PBMC) from patients with pulmonary TB (n = 20), extra-pulmonary TB (n = 13) and from healthy volunteers (n = 9). Recombinant 32-kDa M. bovis stimulated PBMC from TB patients produced significantly lower levels of IFN-γ at 0 month, and increased at 2-4, and 6 months of treatment and were highly significant (p < 0.000) compared to the responses in controls. The ratios of IFN-γ to IL-10 were low in patients newly diagnosed and improved both during and after treatment. The present study concludes that the levels of in vitro response to M. bovis BCG r32-kDa Ag leading to the specific release of IFN-γ increased after anti-tuberculosis treatment and seems to reflect the clinical status of the patient, thus reiterating the utility of this antigen in T cell based assays as a surrogate marker of cell mediated responses

Age-related waning of Interferon-γ levels against r32kDaBCG in BCG vaccinated children-0

<p><b>Copyright information:</b></p><p>Taken from "Age-related waning of Interferon-γ levels against r32kDaBCG in BCG vaccinated children"</p><p>http://www.jibtherapies.com/content/5/1/8</p><p>Journal of Immune Based Therapies and Vaccines 2007;5():8-8.</p><p>Published online 7 Jun 2007</p><p>PMCID:PMC1899498.</p><p></p> 6 years & 9–12 years (3316 ± 718 & 1360 ± 344; p < 0.003). (b) 6–8 years and 9–12 years (2880 ± 733 & 1360 ± 344; p < 0.01). (a

Age-related waning of Interferon-γ levels against r32kDaBCG in BCG vaccinated children-1

<p><b>Copyright information:</b></p><p>Taken from "Age-related waning of Interferon-γ levels against r32kDaBCG in BCG vaccinated children"</p><p>http://www.jibtherapies.com/content/5/1/8</p><p>Journal of Immune Based Therapies and Vaccines 2007;5():8-8.</p><p>Published online 7 Jun 2007</p><p>PMCID:PMC1899498.</p><p></p>alues. Scar positive Vs. Scar negative: p < 0.000

Synthesis and electronic properties of pyridine end capped cyclopentadithiophene-vinylene oligomers

A series of four oligomers of cyclopentadithiophene-vinylenes end capped with pyridine groups was prepared and their optical and electronic properties studied. Treatment with trifluoroacetic acid (TFA) leads to the bisprotonation of the nitrogens of the pyridine, which has an important impact on the optical properties. Excess treatment with TFA provokes the oxidation of the conjugated core, generating radical cations and dications. The ease of the TFA treatment in solution was extended to protonation in the solid-state where further characterization of the neutral and TFA-treated samples was carried out in electrically active substrates in organic field-effect transistors. Finally, the new molecules were found to be excellent conductors in single-molecule junctions thanks to strong electron delocalization and resonance orbital mediated transport. These studies show the opening of a spectrum of possibilities by suitable terminal substitution of π-cores

SPIRIT 2013 checklist: Recommended items to address in an Interventional trial protocol and related documents*.

SPIRIT 2013 checklist: Recommended items to address in an Interventional trial protocol and related documents*.</p