Obstetric and perinatal outcomes of expectant management and immediate induction of labour in term premature rupture of membranes: promising outcomes from expectant management cohort

Background: Premature rupture of membranes (PROM) is common obstetric entity, the management even at term is controversial and there is no consensus for definite protocol of management. Objective of the present study is to compare the effectiveness, safety of expectant management of 24 hours and immediate induction with PGE2 gel in terms of maternal and fetal outcome in term PROM.Methods: 200 women were randomized to group A expectant management and group B immediate induction, after strict Inclusion and exclusion criteria. In expectant group waiting period was 24 hours. Multiple end points were examined throughout management. Chi square test and independent t tests were performed for statistical analysis. P value<0.05 was considered significant.Results: Demographic parameters of patients, maternal and gestational age were similar in both groups. Primigravidae were more in both groups A and B. Vaginal delivery rate is more in expectant group and Caesarean Section rate is high in immediate induction group. CS rate was 37% and 23% in group A and B respectively; the difference is statistically significant (p value=0.031). ‘ROM to delivery interval’ was more in group A (16.31±8.67 hrs and 13.85±5.46 hrs) (p value=0.0256). Hospital stay was comparatively more in group A (5.40±0.81 days and 4.11±0.86 days) (p value=0.435). Infective morbidity of mother and baby was low in both groups and no difference was seen.Conclusions: An expectant management allows a good number of women to go into labour and deliver vaginally without an increase in CS rate and infectious morbidity for mother and fetus

A prospective, randomized, cross sectional study of manual versus vacuum extraction of mobile head in caesarean section

Background: Considering the high rate of caesarean section, and the difficulty during delivery of the floating foetal head even by the most experienced obstetrician, the use of vacuum has been described. The present study was undertaken with the hypothesis that, vacuum assisted foetal head delivery during caesarean section is safe and effective without increasing maternal and neonatal complications. The outcomes enumerated by the limited literature available need to be evaluated before it is used routinely.Methods: A prospective, randomized, comparative, cross sectional Hospital based study was conducted at St. Philomena’s Hospital, Bangalore. Every woman randomized for the study received either conventional method or ventouse extraction of fetal head at cesarean section. 200 women were enrolled into the study with 100 in each arm. The primary outcome measures were percentage of successful extractions and I-D interval. The secondary outcome measures were, uterine incision extension, estimated blood loss, Apgar scores, neonatal hyperbilirubinemia and neonatal scalp or head injury.Results: Successful extraction was done in 89 % and 98 % cases in manual and vacuum extraction cases. (p =0.0184). U-D interval in the manual extraction group was 66.59±4.64 seconds and in the Vacuum extraction group it was 56.06±3.46 seconds (P&lt;0.001). The mean pre-delivery hemoglobin levels in group I was 11.6±0.73 compared to 11.36±0.49 gm% in group II. The mean post-delivery hemoglobin levels in group I was 10.29±0.79 compared to 10.21±0.53 gm% in group II (p &lt;0.001). The uterine incision extensions were significantly higher in manual extraction group, 18 of the 100 women (18 %), whereas only 2 of the 100 women in vacuum group had uterine extensions (p=0.0002).Conclusions: Authors conclude that the routine use of ventouse is safe and effective for mobile fetal head extraction at cesarean section

Post-training load-related changes of auditory working memory: An EEG study

Working memory (WM) refers to the temporary retention and manipulation of information, and its capacity is highly susceptible to training. Yet, the neural mechanisms that allow for increased performance under demanding conditions are not fully understood. We expected that post-training efficiency in WM performance modulates neural processing during high load tasks. We tested this hypothesis, using electroencephalography (EEG) (N = 39), by comparing source space spectral power of healthy adults performing low and high load auditory WM tasks. Prior to the assessment, participants either underwent a modality-specific auditory WM training, or a modality-irrelevant tactile WM training, or were not trained (active control). After a modality-specific training participants showed higher behavioral performance, compared to the control. EEG data analysis revealed general effects of WM load, across all training groups, in the theta-, alpha-, and beta-frequency bands. With increased load theta-band power increased over frontal, and decreased over parietal areas. Centro-parietal alpha-band power and central beta-band power decreased with load. Interestingly, in the high load condition a tendency toward reduced beta-band power in the right medial temporal lobe was observed in the modality-specific WM training group compared to the modality-irrelevant and active control groups. Our finding that WM processing during the high load condition changed after modality-specific WM training, showing reduced beta-band activity in voice-selective regions, possibly indicates a more efficient maintenance of task-relevant stimuli. The general load effects suggest that WM performance at high load demands involves complementary mechanisms, combining a strengthening of task-relevant and a suppression of task-irrelevant processing

Role of informal healthcare providers in tuberculosis care in low- and middle-income countries: A systematic scoping review.

Achieving targets set in the End TB Strategy is still a distant goal for many Low- and Middle-Income Countries (LMICs). The importance of strengthening public-private partnership by engaging all identified providers in Tuberculosis (TB) care has long been advocated in global TB policies and strategies. However, Informal Healthcare Providers (IPs) are not yet prioritised and engaged in National Tuberculosis Programs (NTPs) globally. There exists a substantial body of evidence that confirms an important contribution of IPs in TB care. A systematic understanding of their role is necessary to ascertain their potential in improving TB care in LMICs. The purpose of this review is to scope the role of IPs in TB care. The scoping review was guided by a framework developed by the Joanna Briggs Institute. An electronic search of literature was conducted in MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, and Web of Science. Of a total 5234 records identified and retrieved, 92 full-text articles were screened, of which 13 were included in the final review. An increasing trend was observed in publication over time, with most published between 2010-2019. In 60% of the articles, NTPs were mentioned as a collaborator in the study. For detection and diagnosis, IPs were primarily involved in identifying and referring patients. Administering DOT (Directly Observed Treatment) to the patient was the major task assigned to IPs for treatment and support. There is a paucity of evidence on prevention, as only one study involved IPs to perform this role. Traditional health providers were the most commonly featured, but there was not much variation in the role by provider type. All studies reported a positive role of IPs in improving TB care outcomes. This review demonstrates that IPs can be successfully engaged in various roles in TB care with appropriate support and training. Their contribution can support countries to achieve their national and global targets if prioritized in National TB Programs

High-efficiency beam extraction and collimation using channeling in very short bent crystals

silicon crystal was used to channel and extract 70 GeV protons from the U-70 accelerator with an efficiency of 85.3±2.8%, as measured for a beam of ∼1012 protons directed towards crystals of ∼2 mm length in spills of ∼2 s duration. The experimental data follow very well the prediction of Monte Carlo simulations. This demonstration is important in devising a more efficient use of the U-70 accelerator in Protvino and provides crucial support for implementing crystal-assisted slow extraction and collimation in other machines, such as the Tevatron, RHIC, the AGS, the SNS, COSY, and the LHC

Bullous pemphigoid and comorbidities: a case-control study in Portuguese patients

BACKGROUND: Although rare, bullous pemphigoid (BP) is the most common autoimmune blistering disease. Recent studies have shown that patients with bullous pemphigoid are more likely to have neurological and psychiatric diseases, particularly prior to the diagnosis of bullous pemphigoid. OBJECTIVE: The aims were: (i) to evaluate the demographic and clinical features of bullous pemphigoid from a database of patients at a Portuguese university hospital and (ii) to compare the prevalence of comorbid conditions before the diagnosis of bullous pemphigoid with a control group. METHODS: Seventy-seven patients with bullous pemphigoid were enrolled in the study. They were compared with 176 age- and gender-matched controls, which also had the same inpatient to outpatient ratio, but no history of bullous or cutaneous malignant disease. Univariate and multivariate analyses were used to calculate odds ratios for specific comorbid diseases. RESULTS: At least one neurologic diagnosis was present in 55.8% of BP patients compared with 20.5% controls (p<0.001). Comparing cases to controls, stroke was seen in 35.1 vs. 6.8%, OR 8.10 (3.80-17.25); dementia in 37.7 vs. 11.9%, OR 5.25 (2.71-10.16); and Parkinson's disease in 5.2 vs. 1.1%, OR 4.91 (0.88-27.44). Using multivariate analysis, all diseases except Parkinson's retained their association with BP. Patients under systemic treatment were eight times more likely to have complications than those treated with topical steroids (p< 0.017). CONCLUSIONS: The results of this study substantiate the association between BP and neurological diseases. In addition, they highlight the potential complications associated with the treatment of BP

Synaptic Plasticity and NO-cGMP-PKG Signaling Regulate Pre- and Postsynaptic Alterations at Rat Lateral Amygdala Synapses Following Fear Conditioning

In vertebrate models of synaptic plasticity, signaling via the putative “retrograde messenger” nitric oxide (NO) has been hypothesized to serve as a critical link between functional and structural alterations at pre- and postsynaptic sites. In the present study, we show that auditory Pavlovian fear conditioning is associated with significant and long-lasting increases in the expression of the postsynaptically-localized protein GluR1 and the presynaptically-localized proteins synaptophysin and synapsin in the lateral amygdala (LA) within 24 hrs following training. Further, we show that rats given intra-LA infusion of either the NR2B-selective antagonist Ifenprodil, the NOS inhibitor 7-Ni, or the PKG inhibitor Rp-8-Br-PET-cGMPS exhibit significant decreases in training-induced expression of GluR1, synaptophysin, and synapsin immunoreactivity in the LA, while those rats infused with the PKG activator 8-Br-cGMP exhibit a significant increase in these proteins in the LA. In contrast, rats given intra-LA infusion of the NO scavenger c-PTIO exhibit a significant decrease in synapsin and synaptophysin expression in the LA, but no significant impairment in the expression of GluR1. Finally, we show that intra-LA infusions of the ROCK inhibitor Y-27632 or the CaMKII inhibitor KN-93 impair training-induced expression of GluR1, synapsin, and synaptophysin in the LA. These findings suggest that the NO-cGMP-PKG, Rho/ROCK, and CaMKII signaling pathways regulate fear memory consolidation, in part, by promoting both pre- and post-synaptic alterations at LA synapses. They further suggest that synaptic plasticity in the LA during auditory fear conditioning promotes alterations at presynaptic sites via NO-driven “retrograde signaling”