Improving pregnancy outcomes in tertiary care institution in India through obstetric intensive care unit: three-year analysis

Background: To analyse the requirement of high dependency unit (HDU)/intensive care unit (ICU) in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome.Methods: Retrospective observational study was carried out from April 2015 to September 2018 at department of obstetrics and gynecology SSG Hospital, Vadodara India. Data related to indications for ICU admission, interventions required, length of stay and outcomes were collected, and results were analyzed.Results: Obstetric ICU utilization rate was 130 per 1000 deliveries.  The major obstetric indications for admission were hypertensive disorders of pregnancy (42%) followed by anemia (25%) and post-partum hemorrhage (3%). In the rest of the patient’s majority (50%) had cardiovascular problems. Maternal mortality among these critically ill women was 3.76%. The death rate in the present study was high among patients admitted for non-obstetric (74.54%) as opposed to obstetric indications (25.46%).Conclusions: Establishment of well managed high dependency and intensive care unit in health care facilities dealing with high volumes of high-risk maternity cases reduces the maternal mortality significantly and results in improved maternal outcomes

A case report on IgA nephropathy in pregnancy

IgA Nephropathy is a primary glomerular disease leading cause of primary glomerulonephritis and one of the important  leading cause of secondary hypertension. Pregnancy causes complex pathological changes in patients with IgA nephropathy affecting the renal function leading to secondary hypertension which in turn affects the prognosis of these patients. The association between chronic kidney disease and increased risk of adverse maternal and fetal outcomes which includes pre-eclampsia, accelerated decline in renal function, intrauterine growth retardation, preterm delivery and fetal death, is well recognised. Management of patients with IgA Nephropathy in pregnancy is challenging and thus authors are discussing here a case with successful outcome. Our patient was a known case of IgA Nephropathy and landed up with complications during pregnancy which was manged successfully.

About Reference Disciplines and Reference Differences: A Critique of Wade et al.

Two articles published in this issue (Wade et al. and ours) through similar analyses reach contrasting conclusions on whether Information Systems, as a field, is evolving toward a reference discipline. In this article, we provide a critique of Wade et al. We first assess our different interpretations of reference discipline, and then discuss the consequences of including highly related disciplines in citation analysis. Finally, we illustrate the sensitivity of Wade et al.\u27s results to the inclusion and exclusion of certain journals. We also consider potential interpretations of second degree citations. It is hoped that the arguments presented here reconcile the differences as we collectively advance thinking on the state of IS as a reference discipline

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

The ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Interstitial ectopic pregnancies are gestations that implant within the proximal, intramural portion of the fallopian tubes with high vascularity. Ectopic pregnancy in the interstitial part of the fallopian tubes can be life-threatening considering the thin myometrial tissue surrounding the gestational sac and high vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. Being a hazardous type of ectopic pregnancy, it becomes extremely important to diagnose and manage it. This condition presents a challenge for clinical as well as radiological diagnosis. Generally, a case of interstitial ectopic pregnancy has typical radiological features distinguishing it from other ectopic. The ultrasonographic finding of interstitial line has better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy. Ultrasound is the mainstay of diagnosis, but magnetic resonance imaging can be helpful in unusual or complicated cases. Interstitial ectopic pregnancy rupturing into the leaves of broad ligament and creating a tamponade effect to alter the clinical presentation is a rare event which presents as a diagnostic challenge. Here authors present a case of ruptured interstitial ectopic pregnancy confined to the leaves of broad ligament, with atypical presentation and radiological features which led to difficulty in diagnosing the interstitial ectopic pregnancy. After laparoscopic confirmation of ruptured interstitial ectopic pregnancy, the patient was managed successfully by laparoscopic cornual resection

Graph Partitioning for Image Segmentation using Iso-Perimetric Algorithm

Graph cuts proved to be a useful multidimensional optimization tool which can enforce piecewise smoothness while preserving relevant sharp discontinuities. This paper is mainly intended as an application of isoperimetric algorithm of graph theory for image segmentation and analysis of different parameters used in the algorithm like generating weights, regulates the execution, Connectivity Parameter,cutoff, number of recursions,. We present some basic background information on graph cuts and discussmaj or theoretical results,which helped to reveal both strengths and limitations of this surprisingly versatile combinatorial algorithm

Eradication of weeds by mechanical methods in Central India

Call number: LD2668 .R4 1963 C61

A Citation Analysis of the Evolution and State of Information Systems within a Constellation of Reference Disciplines

For the past two decades notions of cumulative tradition and reference disciplines have been a significant part of the introspective debates on the IS field. We provide an exploratory test on these notions using sociometric analysis. In doing so, we extend the work of Culnan and Swanson originally carried out about 25 years ago. By using the concept of a work point and reference points to identify where an IS article is published and the extent to which it draws from or contributes to other disciplines, we can position research in the IS field. First, a quantitative analysis of over 72,600 citations spread across 1406 IS articles in 16 journals over the period 1990-2003 reveals a distinct trend toward a cumulative tradition, a changing mix of reference disciplines, and a two-way relationship between IS and some of the more mature disciplines. Second, post-hoc content analysis provides a glimpse of how IS work is being utilized by other disciplines. Overall, our analysis indicates that IS is taking up a more socio-technical persona, building upon its own knowledge base, and repaying its debts by contributing to other disciplines. We interpret the movement towards building a cumulative tradition, and informing work in other disciplines as positive, as we strive toward being part of an intellectual network and establish centrality in areas that matter to us most

Thermal stabilization of thymidylate synthase by engineering two disulfide bridges across the dimer interface

Thermal inactivation of oligomeric enzymes is most often irreversible and is frequently accompanied by precipitation. We have engineered two symmetry related disulfide bridges (155-188′ and 188-155′) across the subunit interface of Lactobacillus casei thymidylate synthase, at sites chosen on the basis of an algorithm for the introduction of stereochemically unstrained bridges into proteins. In this communication, we demonstrate a remarkable enhancement in the thermal stability of the covalently cross-linked double disulfide containing dimeric enzyme. The mutant enzyme remains soluble and retains secondary structure even at 90°C, in contrast to the wild-type enzyme which precipitates at 52°C. Furthermore, the mutant enzyme has a temperature optimum of 55°C and possesses appreciable enzymatic activity at 65°C. Cooling restores complete activity, in the mutant protein, demonstrating reversible thermal unfolding. The results suggest that inter-subunit crosslinks can impart appreciable thermal stability in multimeric enzymes

Design of an Advanced Layered Composite for Energy Dissipation using a 3D-Lattice of Micro Compliant Mechanism

This work introduces a new Advanced Layered Composite (ALC) design that redirects impact load through the action of a lattice of 3D printed micro-compliant mechanisms. The first layer directly comes in contact with the impacting body and its function is to prevent an intrusion of the impacting body and uniformly distribute the impact forces over a large area. This layer can be made from fiber woven composites imbibed in the polymer matrix or from metals. The third layer is to serve a purpose of establishing contact between the protective structure and body to be protected. It can be a cushioning material or a hard metal depending on the application. The second layer is a compliant buffer zone (CBZ) which is sandwiched between two other layers is responsible for the dampening of most of the impact energy. The compliant buffer zone, comprised by the lattice of micro-compliant mechanism, is designed using topology optimization to dynamically respond by distributing localized impact in the normal direction into a distributed load in the radial direction (perpendicular to the normal direction). The compliant buffer zone depicts a large radial deformation in the middle but not on the surface, which only moves in the normal direction. The effect is a significant reduction of the interfacial shear stress with two adjacent layered phases. A low interfacial shear stress translates into a reduced delamination. The ALC’s response to the impact is tested by using dynamic finite element analysis. The proposed ALC design is intended to be used for the design of protective devices such as helmets and crashworthy components in vehicle structures