LSCS notes audit in a tertiary referral centre of Uttar Pradesh, India

Background: Obstetrics is a very litigious branch as the nature of job is highly pressured and it deals with two lives a mother and baby/babies. There are situations where there are no mistakes but there is no ‘documentation’ of due to high turnover of labouring women which leads to difficulty in dealing with medico legal cases. It is due to this reasons we decided to do an audit of our Caesarean section operative notes.Methods: We planned to audit the quality of caesarean section documentation in a University teaching hospital of North India at Banaras Hindu University. The study involved 57 case notes from the first January 2015 to 24 February 2015. The proforma was filled by residents within 72 hours of the operative procedure.Results: Date of Lower Segment Caesarean Section (LSCS) was from 01.01.2015 to 24.02.2015 and total of 57 case notes were included in this study. Hospital number, date of LSCS and time of LSCS was written in the operative notes of all patients. Written consent was also taken from patient party in all cases of LSCS. There were 6 cases of General anaesthesia (GA) in which two GA were preceded by spinal which had failed. Hand writing was legible in all records and was written by second year residents and signed.Conclusions: The above audit done at University teaching hospital of North India at Banaras Hindu University which included 57 notes shows a very high quality of record maintenance. This audit was conducted while the Obstetric team was aware that audit of record keeping is taking place. It is difficult to ascertain whether such a high level of record maintenance is a true reflection or a Hawthorne effect.

Evaluation of in vitro and invivo anti-inflammatory activities of Parthenium camphora

The present investigation was carried out to evaluate the anti-inflammatory potential of solvent extracts of Parthenium camphora (Family: Compositae), a non-useful and waste weed growing through waste sides. The anti-inflammatory activities were assessed through in vitro and in vivo procedures, the results were found to be very surprising and promising. Aqueous and Ethanolic solvent extracts of Parthenium camphora were found to have significant anti-inflammatory activity at doses 100 and 120 mg/Kg during in vitro anti-inflammatory assay. The ethanolic fractions of the plant causes significant reduction in inflammation i.e. 92 % (120 mg/kg) followed by aqueous extract i.e. 85 % (120 mg/kg) compared to standard anti-inflammatory drug, Diclofenac Sodium i.e. 87 % (10 mg/kg). The values of reduction in paw volume, 0.10 ± 0.05, 0.14 ± 0.05 and 0.16 ± 0.05 were found significantly of ethanol extract, aqueous extract and Diclofenac sodium, respectively at 4 h after carrageenan administration. Ethanolic extracts showed potent anti-inflammatory activity in comparison to aqueous extracts. The extracts showed higher anti-inflammatory potential as the dose varies. Thus results showed that extracts showed significant anti-inflammatory activity in dose-dependent manner. The extracts exhibited membrane stabilization effect by inhibiting hypotonicity induced lysis of erythrocyte membrane. The erythrocyte membrane is analogous to the lysosomal membrane, and its stabilization implies that the extract may as well stabilize lysosomal membrane. Stabilization of lysosomal membrane is important in limiting the inflammatory response by preventing the release of lysosomal constituents of activated neutrophils such as bacterial enzymes and proteases which cause further tissue inflammation and damage. From the above study it was concluded that the ethanolic extract of Parthenium camphora has significant membrane stabilization property compared to the aqueous extract of the same plant and it was comparable to the standard drug Diclofenac Sodium

Bicriteria in n x 2 Flow Shop Scheduling Under Specified Rental Policy, Processing Time and Setup Time Each Associated with probabilities Including Job Block

This paper is an attempt to obtains an optimal solution for minimizing the bicriteria taken as minimizing thetotal rental cost of the machines subject to obtain the minimum makespan for n jobs 2 machines flowshopproblem in which the processing times and independent set up times are associated with probabilitiesincluding the job block concept. A heuristic approach method to find optimal or near optimal sequence hasbeen discussed. The proposed method is very simple and easy to understand and also provide an importanttool for the decision makers. A computer programme followed by a numerical illustration is give to clarifythe algorithm.Keywords: Flowshop Scheduling, Heuristic, Processing Time, Set Up Time, Rental Cost and Job Block

Thanatophoric dysplasia: a rare entity

Thanatophoric dysplasia (TD), a rare and lethal skeletal dysplasia of neonatal period. Two clinical forms of Thanatophoric dysplasia have been described. TD is caused by specific autosomal dominant mutations in the gene that codifies for the Fibroblast Growth Factor Receptor 3 (FGFR3). The mutations constitutively activate the tyrosine kinase activity of the receptor. The estimated birth incidence is approximately 1/20,000 to 1/50,000. TD I being more frequent than TD II. Most individuals with TD die within the first few hours or days of life. Currently, specific therapeutic regiments do not exist. Prenatal diagnosis is available, both by ultrasonography and by molecular studies. This case report describes fetus with one of this rare disorder

Bicriteria in n x 2 Flow Shop Scheduling Problem under Specified Rental Policy, Processing Time, Setup Time Each Associated with Probabilities Including Job Block Criteria and Weightage of Jobs

This paper is an attempt to obtain an optimal solution for minimizing the bicriteria taken as minimization of the total rental cost of the machines subject to obtain the minimum makespan for n-jobs, 2-machine flow shop scheduling problem in which the processing times and independent set up times are associated with probabilities including job block criteria. Further jobs are attached with weights to indicate their relative importance. The proposed method is very simple and easy to understand and also provide an important tool for the decision makers. A computer programme followed by a numerical illustration is given to justify the algorithm. Keywords: Flowshop Scheduling, Heuristic, Processing Time, Setup Time, Job Block, Weighs of job

Heterotopic pregnancy: a catastrophic event

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of heterotopic pregnancy in a 25-year-old woman presenting with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 12 weeks of amenorrhea, diagnosed on ultrasound examination

Comparative study of ultrasound guided supra-scapular nerve block versus intra-articular steroid injection in frozen shoulder

Background: Frozen shoulder is one of the most common musculoskeletal problems seen in orthopaedics. Many treatment modes are available however, it is difficult to treat and data on the comparative efficacy of various interventions are limited. Intra-articular corticosteroid injection (IASI) is a commonly used to treat frozen shoulder pain. Supra-scapular nerve block (SSNB) is also effective method to treat pain in chronic diseases that affect the shoulder. The present study was done to compare efficacy of ultrasound guided SSNB and IASI in management of painful frozen shoulder.Methods: 60 patients with painful frozen shoulder were divided in two groups, Group A received ultra-sound guided SSNB with 6 ml 0.5% Bupivacaine; Group B received IASI using 40 mg Triamcinolone. Outcome measures were shoulder ranges mainly lateral rotation and abduction, shoulder pain and disability index and visual analogue scale (VAS). Patients were followed-up on 2nd day, at 1st, 3rd and 6th week.Results: All baseline parameters improved significantly in both groups; however, on comparison Group A showed significant improvement in passive lateral rotation on 2nd day and 1st week follow up (P =0.038 and 0.040 respectively). VAS score showed significance at all follow-up in Group A, whereas, in Group B significance was seen after 1 week. On inter group comparison Group A shows significance on 2nd day (P =0.050), 1st week (P =0.042) and 3rd week (P =0.036).Conclusions:Both SSNB and IASI have efficacy in management of frozen shoulder. But supra-scapular nerve block is better than intra-articular injection and should be considered prior to steroid as it has early onset pain relief, early improvement in ranges, potentially lesser contraindications and side effects.

Stinespring's Theorem for Maps on Hilbert C*- Modules

Stinespring's representation theorem is a fundamental theorem in the theory of completely positive maps. It is a structure theorem for completely positive maps from a C*- algebra into the C*- algebra of bounded operators on a Hilbert space. This theorem provides a representation for completely positive maps, showing that they are simple modifications of *- homomorphisms. One may consider it as a natural generalization of the well-known Gelfand-Naimark-Segal theorem for states on C*-algebras. Resently, a theorem which looks like Stinesprings theorem was presented by Mohammad B. Asadi in for a class of unital maps on Hilbert C*-modules. This result can also be proved by removing a techical condition of Asadis theorem. The assumption of unitality on maps under consideration can also be remove. This result looks even more like Stinesprings theorem

Mathematical Models Used for Brachytherapy Treatment Planning Dose Calculation Algorithms

Brachytherapy treatment is primarily used for the certain handling kinds of cancerous tumors. Using radionuclides for the study of tumors has been studied for a very long time, but the introduction of mathematical models or radiobiological models has made treatment planning easy. Using mathematical models helps to compute the survival probabilities of irradiated tissues and cancer cells. With the expansion of using HDR-High dose rate Brachytherapy and LDR-low dose rate Brachytherapy for the treatment of cancer, it requires fractionated does treatment plan to irradiate the tumor. In this paper, authors have discussed dose calculation algorithms that are used in Brachytherapy treatment planning. Precise and less time-consuming calculations using 3D dose distribution for the patient is one of the important necessities in modern radiation oncology. For this it is required to have accurate algorithms which help in TPS. There are certain limitations with the algorithm which are used for calculating the dose. This work is done to evaluate the correctness of five algorithms that are presently employed for treatment planning, including pencil beam convolution (PBC), superposition (SP), anisotropic analytical algorithm (AAA), Monte Carlo (MC), Clarkson Method, Fast Fourier Transform, Convolution method. The algorithms used in radiotherapy treatment planning are categorized as correction‐based and model‐based

Uterine inversion: a shocking aftermath of mismanaged third stage of labour

Background: To study the incidence, causes, clinical presentations, management and maternal morbidity and mortality associated with acute puerperal inversion of uterus.Methods: This retrospective study was conducted in Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur, from March 2008 to March 2013. All the women who developed acute puerperal inversion of uterus either in or outside our hospital were included in the study.Results: Majority of women presenting with inversion belonged to age group 20-35 years, were multigravida (68.2%), came from rural set-up (81.4%) and were unbooked (81.8%). Majority of deliveries complicated by inversion took place at home (50%), delivered by dais (46%). Mismanaged 3rd stage of labour proved to be an important factor (36.4%) leading to inversion uterus followed by atonicity of uterus. 90% of women suffered due to delay in management at PHC and CHC, 68%women succumbed to delay in diagnosis at the place of delivery by untrained staff, whereas 45% women suffered due to delay in transport facility. 13.63% women suffered from sepsis in post-operative period, 22.72% from renal failure whereas 18.18% died.Conclusion: Proper education and training regarding active management of third stage of labour, diagnosis and management of uterine inversion should be imparted to traditional birth attendants, so that this potentially life-threatening obstetric emergency could be averted