Ruptured uterus outcome among the pregnant women admitted in a tertiary care centre

Background: Rupture of a previously unscarred uterus is usually a catastrophic event resulting in death of the baby and sometimes even maternal death from blood loss. Incidence of rupture uterus varies from 0.3/1000 to 7/1000 deliveries in India accounting for 5% to 10% of all maternal deaths. Hence, the present study was conducted to study the proportion of ruptured uterus among the antenatal women admitted, their associated clinical spectrum and maternal outcome.Methods: A cross sectional study was carried out among 46 antenatal women presented with ruptured uterus in the department of Obstetrics and Gynaecology at N.S.C.B medical college and Hospital at Jabalpur, (M.P) during 1st August 2011 to 31st August 2012.Results: The incidence of ruptured uterus was 1 in 118 (0.84%) of all hospital deliveries. Mostly, 18 (39.1%) patients were in 26 -30yrs of age. Maximum, 22 patients (47.83%) with ruptured uterus were in second gravidae. Most common site of scar rupture was lower uterine segment, observed in 42 (91.30%) patients. The most common form of management was rent repair done in 36 (78.26%) patients, followed by subtotal hysterectomy (STH) in 8 (17.39%) and total hysterectomy (TH) in 2(4.34%) patients. A perinatal mortality was seen in 38 (82.60 %) cases with 1 maternal death was observed.Conclusions: Reducing the primary cesarean section rate and early diagnosis with active surgical management will go a long way in reducing the incidence of ruptured uterus and maternal and fetal mortality

Two-Proton Radioactivity with 2p halo in light mass nuclei A==18−-34

Two-proton radioactivity with 2p halo is reported theoretically in light mass nuclei A $=$ 18-34. We predict $^{19}$Mg, $^{22}$Si, $^{26}$S, $^{30}$Ar and $^{34}$Ca as promising candidates of ground state 2p-radioactivity with S$_{2p}$ $$ 0. Observation of extended tail of spatial charge density distribution, larger charge radius and study of proton single particle states, Fermi energy and the wave functions indicate 2p halo like structure which supports direct 2p emission. The Coulomb and centrifugal barriers in experimentally identified 2p unbound $^{22}$Si show a quasi-bound state that ensures enough life time for such experimental probes. Our predictions are in good accord with experimental and other theoretical data available so far.Comment: 5 Pages, 5 figure

Lessons from an international trial evaluating vaccination strategies for recovered inpatients with COVID-19 (VATICO)

The protection provided by natural versus hybrid immunity from COVID-19 is unclear. We reflect on the challenges from trying to conduct a randomized post-SARS-CoV-2 infection vaccination trial study with rapidly evolving scientific data, vaccination guidelines, varying international policies, difficulties with vaccine availability, vaccine hesitancy, and a constantly evolving virus

Evolution of Shapes and Search for Shape Coexistence in Sd-Shell Nuclei

A detailed and systematic study has been performed using state dependent Relativistic Mean-Field plus BCS (RMF+BCS) approach to investigate shape evolution for even-even isotopes of Ne, Mg, Si and S. We perform quadrupole constraint calculation using NL3* parameter and look into the variation of binding energy with respect to deformation and find the shape and deformation corresponding to energy minima. We find various isotopes showing shape coexistence and shape transition while moving from proton drip-line to neutron drip-line. These results are compared with Macroscopic-microscopic approach (Mac-Mic) with Nilson Strutinsky (NS) prescription and some other works and are found consistent for these sd-shell nuclei

Patient and provider‐level barriers to hepatitis C screening and linkage to care: A mixed‐methods evaluation

Achieving practice change can be challenging when guidelines shift from a selective risk‐based strategy to a broader population health strategy, as occurred for hepatitis C (HCV) screening (2012‐2013). We aimed to evaluate patient and provider barriers that contributed to suboptimal HCV screening and linkage‐to‐care rates after implementation of an intervention to improve HCV screening and linkage‐to‐care processes in a large, public integrated healthcare system following the guidelines change. As part of a mixed‐methods study, we collected data through patient surveys (n = 159), focus groups (n = 9) and structured observation of providers and staff (n = 9). We used these findings to then inform domains for the second phase, which consisted of semi‐structured interviews with patients across the screening‐treatment continuum (n = 24) and providers and staff at primary care and hepatology clinics (n = 21). We transcribed and thematically analysed interviews using an integrated inductive and deductive framework. We identified lack of clarity about treatment cost, treatment complications and likelihood of cure as ongoing patient‐level barriers to screening and linkage to care. Provider‐level barriers included scepticism about establishing HCV screening as a quality metric given competing clinical priorities, particularly for patients with multiple comorbidities. However, most felt positively about adding HCV as a quality metric to enhance HCV screening and linkage to care. Provider engagement yielded suggestions for process improvements that resulted in increased stakeholder buy‐in and real‐time enhancements to the HCV screening process intervention. Systematic data collection at baseline and during practice change implementation may facilitate adoption and adaptation to improve HCV screening guideline implementation. Findings identified several key opportunities and lessons to enhance the impact of practice change interventions to improve HCV screening and treatment delivery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155892/1/jvh13278.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155892/2/jvh13278_am.pd

Derivation of a Protein Risk Score for Cardiovascular Disease Among a Multiracial and Multiethnic HIV+ Cohort

Background Cardiovascular disease risk prediction models underestimate CVD risk in people living with HIV (PLWH). Our goal is to derive a risk score based on protein biomarkers that could be used to predict CVD in PLWH. Methods and Results In a matched case-control study, we analyzed normalized protein expression data for participants enrolled in 1 of 4 trials conducted by INSIGHT (International Network for Strategic Initiatives in Global HIV Trials). We used dimension reduction, variable selection and resampling methods, and multivariable conditional logistic regression models to determine candidate protein biomarkers and to generate a protein score for predicting CVD in PLWH. We internally validated our findings using bootstrap. A protein score that was derived from 8 proteins (including HGF [hepatocyte growth factor] and interleukin-6) was found to be associated with an increased risk of CVD after adjustment for CVD and HIV factors (odds ratio: 2.17 [95% CI: 1.58-2.99]). The protein score improved CVD prediction when compared with predicting CVD risk using the individual proteins that comprised the protein score. Individuals with a protein score above the median score were 3.10 (95% CI, 1.83-5.41) times more likely to develop CVD than those with a protein score below the median score. Conclusions A panel of blood biomarkers may help identify PLWH at a high risk for developing CVD. If validated, such a score could be used in conjunction with established factors to identify CVD at-risk individuals who might benefit from aggressive risk reduction, ultimately shedding light on CVD pathogenesis in PLWH

Understanding the treatment benefit of hyperimmune anti-influenza intravenous immunoglobulin (Flu-IVIG) for severe human influenza

Background: Antibody-based therapies for respiratory viruses are of increasing importance. The INSIGHT 006 trial administered anti-influenza hyperimmune intravenous immunoglobulin (Flu-IVIG) to patients hospitalized with influenza. Flu-IVIG treatment improved outcomes in patients with influenza B but showed no benefit for influenza A. Methods: To probe potential mechanisms of Flu-IVIG utility, sera collected from patients hospitalized with influenza A or B viruses (IAV or IBV) were analyzed for antibody isotype/subclass and Fcγ receptor (FcγR) binding by ELISA, bead-based multiplex, and NK cell activation assays. Results: Influenza-specific FcγR-binding antibodies were elevated in Flu-IVIG–infused IBV- and IAV-infected patients. In IBV-infected participants (n = 62), increased IgG3 and FcγR binding were associated with more favorable outcomes. Flu-IVIG therapy also improved the odds of a more favorable outcome in patients with low levels of anti-IBV Fc-functional antibody. Higher FcγR-binding antibody was associated with less favorable outcomes in IAV-infected patients (n = 50), and Flu-IVIG worsened the odds of a favorable outcome in participants with low levels of anti-IAV Fc-functional antibody. Conclusion: These detailed serological analyses provide insights into antibody features and mechanisms required for a successful humoral response against influenza, suggesting that IBV-specific, but not IAV-specific, antibodies with Fc-mediated functions may assist in improving influenza outcome. This work will inform development of improved influenza immunotherapies