A study on maternal near miss cases in Government Medical College Shivpuri, India

Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. It assesses and monitors the activities aimed for prevention of maternal mortality. The aim and objective of this study was to find out the incidence, the prevalence and causes of maternal near miss due to severe obstetric complications and to identify the gapes and contextualize corrective measures to be taken in our facility.Methods: This is a retrospective study done in department of Obstetrics and Gynecology in GMC associated with DHS Shivpuri MP. The study was done during a period from 1st January 2018 to 30 April 2019.Results: In this study the hospital maternal near miss incidence ratio was 14.34%. In our study we found the most common morbidity was (30.18%) hypertensive disorder of pregnancy. These 159 near miss diagnoses were comprised of (30.18 %) cases of Hypertensive disorder of pregnancy, (27.67%) cases of major obstetric hemorrhage, (6.91) Severe systemic infection or sepsis, (4.40%) Labour related disorders. In Medical disorders very Severe Anemia, (1.88%) was most common cause of near miss. The most common cause of death was post-partum hemorrhage 37.5% and most of the patients referred from periphery in very critical condition.  The median time taken to get clinical intervention among cases was 20-40 minutes after admission.Conclusions: Hemorrhage and hypertension disorders are the leading causes of MNM. Prompt diagnosis and adequate management of near miss cases can reduce mortality rates

Risk factor for gestational diabetes mellitus and impact of gestational diabetes mellitus on maternal and fetal health during the antenatal period

Background: Gestational diabetes mellitus (GDM) is defined as any degree of dysglycaemia that occurs for the first time or is first detected during pregnancy. The adverse effects of GDM on pregnant women are pre-eclampsia, PIH, PPH, polyhydramanios, PROM, meanwhile, there would be an increase in dystocia, birth injury, and cesarean sectionMethods: This retrospective study was conducted in a Gynecology clinic in District Shivpuri to find out the various risk factors for GDM and to evaluate the impact of GDM on maternal and fetal health during the antenatal period. 84 patients who were diagnosed with GDM were included in the study. Results: Among risk factors; BMI >25 kg/m2 before pregnancy was found in 15.47% of the case, family history of diabetes mellitus 8.33%, Previous history of macrosomia 17.85%, Poor reproductive history 17.85%, baby with congenital malformation 8.33%, H/o unexplained IUFD 11.90%. H/o polyhydramnios 15.47%. History of PCOS 13.09% and preeclampsia was found in 17.85% of cases. In antenatal complications; miscarriages was found in 15.47%. polyhydramnios in 17.85%. Oligohydramnios in 8.33%, preterm labor in 11.90%, PROM in 9.52%, pre-eclampsia in 17.85%, sudden IUFD in 8.33% and congenital malformation was found in 4.76% of cases. On USG; IUGR was found in 7.14% of cases. Large for date fetus in 16.66% of cases and the normal growth was found in 76.19% of cases.Conclusions- In conclusion appropriate and timely diagnosis and treatment of GDM will result in decreased maternal and neonatal adverse outcomes comparable to general population rates, therefore, early diagnosis is important

Aetiological analysis of primary amenorrhea: a retrospective study

Background: Primary amenorrhea is defined as the failure to reach menarche. Primary amenorrhea is the lack of menses by age 15 with secondary sex characteristics, or at 13 with absence of secondary sex characteristics. Objective was to determine various etiological factors of primary amenorrhea in Gynecological practice.Methods: A retrospective study was conducted in a Gynae clinic in Shivpuri and a Maternity hospital in Gwalior from January 2015 to December 2019.  Results: A total of 57 of the patients were evaluated in the study period. Most of the patients were unmarried adolescent girls (71.92%). The most common presenting symptom was, not attained menarche (36.84%). Based on the presence or absence of breast and uterus: group, I – breast present and uterus present 13 cases (22.77%), group II - breast present and uterus absent 26 cases (45.61%), group III - breast absent and uterus present 17cases (29.79%), group IV - breast absent and uterus absent 1 case (1.75%) were present. The most common etiological factors were Mullerian Agenesis 22 cases (38.60%) and Gonadal dysgenesis 7 cases (12.28%). (56.14 %) cases were normogonadotropic, followed by (15.78%) cases were of Hypergonadotropic hypogonadism, (14.03%) hypogonotropic hypogonadism and (14.03%) were of hyperendrogenism and others causes. In cases of Mullerian abnormalities, in findings of renal ultrasound or IVP (72.72%) cases were normal.Conclusions: The most common etiological factors of primary amenorrhea were Mullerian Agenesis. Amenorrhea is a common problem encountered by the primary care physician. A thorough history and clinical examination are needed for differential diagnosis

The maternal and fetal outcome of repeat previous one caesarean section

Background: The rates of adverse maternal and neonatal outcomes have increased significantly in the last decade. Patients with repeated caesarean deliveries also have a greater risk of placenta previa, placenta accrete, uterine rupture, bowel and bladder injury, and unplanned hysterectomy.Methods: This retrospective study was performed between 01 April 2017 to 31 March 2021, at a private hospital to know about the surgical difficulties and maternal and neonatal complications encountered in cases of repeated LSCS. The outcome of 1028 women admitted with a history of previous LSCS was studied.Results: The 613 patients were given a trial of labour. 40.07% of patients delivered normally. The most common indication for repeat LSCS was CPD in 20.94% and fetal distress 20.12%. The most common complication observed was adhesion in 37.65%. Scar dehiscence in 8.92 %, scar rupture in 0.64%, uterine atony in 4.8%, placenta previa in 3.57%, placenta accrete in 0.64%, injury to the bladder was seen in 0.97%, caesarean hysterectomy was done in only 2 cases and gaped wound was found in 1.13% of cases. 19.15% of neonates were admitted to NICU. Apgar score <7 at 5 minutes in 14.77%. premature neonates were 8.44% RDS was found in 7.62%, birth asphyxia was found in 2.92% cases and neonatal sepsis was found in 1.13%.Conclusions: The dramatic increase in caesarean section rates over the past three decades has been associated with a corresponding increase in maternal morbidity but there a continuous decrease in neonatal morbidity and mortality rates because of advances in neonatal medicine

Fragrance analysis using molecular and biochemical methods in recombinant inbred lines of rice

The aroma or fragrance of Basmati rice is associated with the presence and content of the chemical compound, 2-acetyl-1-pyrroline and the trait is monogenic recessive. Several polymerase chain reaction (PCR)-based co-dominant markers based on RG28 locus were developed, which can differentiate between fragrant and non-fragrant rice cultivars. For molecular and biochemical analysis of aroma, a mapping population comprising 208 recombinant inbred lines (RILs) derived from a diverse cross between CSR10 and Taraori Basmati through Single seed descent (SSD) method was used. RILs are among the best mapping populations, which provide a novel  material for linkage mapping of genes/QTLs marker for various traits. Biochemical analysis of aroma was performed with the 1.7% KOH solution and molecular analysis of aroma was carried out with microsatellite markers present on chromosome 8 (BAD2, BADEX7-5, SCUSSR1) to determine the extent of association between trait, marker and chromosome 8. Among these markers, BAD2 amplified aroma specific alleles having 256 bp in 72 lines, BADEX7-5 with 95 bp in 74 lines and SCUSSR1 with 129 bp in 79 lines. Mantel test of significance detected by biochemical analysis of RILs (with 1.7% KOH) and molecular marker study revealed high degree (&gt;90%) of association of aroma with the above mentioned markers, respectively. Some of the F10 lines amplified the heterozygous alleles for two sets of specific markers (BAD2 and SCUSSR-1) but did not show the presence of aroma as analyzed by chemical test. Aromatic and non-aromatic lines were almost common in three markers, indicating association of markers with the trait and chromosome 8. The results reveal that these markers could be used for marker assisted selection and RIL population for mapping of aroma QTLs/genes.Key words: Basmati, recombinant inbred lines, fragrance, association

A randomized clinical study to compare pre-emptive analgesic efficacy of clonidine and diclofenac sodium in patients undergoing major surgeries at a tertiary care hospital

Background: Pre-emptive analgesia is a method to achieve analgesia even before exposure to a noxious stimulus The purpose of pre-emptive analgesia is to reduce pain caused due to surgical incision triggered inflammatory mechanism activation; and to ensure a good post-operative pain control so that there is no development of chronic pain. Clonidine is an α2 adrenergic agonist thus it decreases the sympathetic outflow, while Diclofenac is a non-steroidal anti-inflammatory agent. Our literature review showed that both clonidine (150 μg) and diclofenac are efficacious pre-emptive analgesics. Literature review also revealed that there is no study available to compare pre-emptive analgesic efficacy as well as safety of oral clonidine with diclofenac, therefore present study was designed to compare pre emptive analgesic efficacy of these two drugs.Methods: This randomized clinical study included 100 patients from surgical departments, of either sex, between 18 to 70 years age and of American society of anesthesiologists (ASA) I/II grade. Patients were randomly allocated to two groups and received either of the treatments 30 minutes prior to induction of anesthesia. Pain scores were recorded using visual analog scale, facial rating scale and behavioral rating scale at awakening and at 1, 2, 4, 6 and 24 hours. Postoperative analgesic requirement over 24 hours was recorded. Data were analyzed using OpenEpi statistical softwares.Results: Significantly lower pain scores were observed in clonidine group as compared to Diclofenac at 4 and 6 hours (p<0.05) on all the pain scales. Clonidine group also required less postoperative analgesic as compared to diclofenac (p<0.05).Conclusions: Study results are strongly suggestive of greater pre-emptive analgesic efficacy of clonidine over diclofenac in major surgeries done under spinal anesthesia

Structure of ll- VI Lattice Mismatched Epilayers used for Blue-Green Lasers for Underwater Communication

Critical thickness (hc) is calculated for capped and uncapped lattice mismatched II-VIsemiconductor epilayers. Both the old equilibrium theory and the improved theory have been used.The calculated values are compared with the experimental data on epilayers of several II-VIsemiconductors and alloys. The observed values of hc are larger than the calculated values. Howeverthe discrepancy is much smaller than that found in InGaAs/GaAs and GeSilSi layers. Moreover ascompared to InGaAs/GaA.s:a nd GeSilSi layers, the experimental data show a much smaller scatter andcan be fitted with one curve. Strain relaxation in layers with thickness h &gt; hc is also calculated. Strainrelaxation in ZnSe layers grown on (100) GaAs shows good agreement with the equilibrium theory. Inother cases the observed relaxation is sluggish, the residual strain is larger than its calculated value.Thick highly mismatched layers behave differently. The residual strain agrees with theory anddislocations are distributed periodically, A model to interpret these observations is suggested.Implications of this study on the stability of 11V- I strained layers are discussed

Numerical simulation on Bay of Bengal's response to cyclones using the Princeton ocean model

This study used the Princeton ocean model (POM) which includes second-order turbulent closure scheme to investigate the fluid dynamics of the Bay of Bengal (BoB) in the upper ocean's response to a cyclone. The model uses an orthogonal curvilinear grid and 26 sigma levels in conformity with realistic bottom topography. The model is forced with wind and heat plus salinity fluxes as surface forcing to simulate the BoB's response during a cyclone. In order to provide the realistic cyclonic vortex the model as input, the synthetic cyclonic vortex is generated and superimposed on the QSCAT/NCEP blended ocean wind fields. Analyses of results show significant sea surface temperature (SST) cooling on both sides of the storm track. This cooling could be attributed to the strong cyclonic winds, surface divergence and upwelling. However, less commonly observed features such as a leftward bias in SST cooling due to the relatively slower motion of TC and southward moving coastal boundary currents are also reported in this study. Model SST is compared with the observed Tropical Rainfall Measuring Mission (TRMM) Microwave Imager (TMI) filled up SST for the evaluation of the model's performance. Moreover, not only sea surface cooling but subsurface warming due to intense downwelling and coastal jet parallel to the coast were also observed in the model's simulation. The mixed layer depth (MLD) variation is revealed by the model. MLD deepening due to the convergence of near surface flow at the periphery of the cyclone is observed; however, beneath the cyclone centre, in the direction of the track the upsloping of isotherms due to the surface divergence and upwelling causes the shoaling of the MLD. Modeled surface currents are compared with 5-day interval OSCAR (Ocean Surface Current Analyses - Real time) surface currents, which are not very coherent, though some of the important features like higher values of boundary layer currents are captured. However, strong near surface, asymmetrical responses such as divergent currents in the open oceanic region are reflected by the model but when the cyclone approaches the coast the current patterns do not show the right bias due to interaction with the coast.Este estudo utilizou o modelo oceânico de Princeton (MOP), que inclui o esquema fechamento turbulento de segunda ordem, para investigar a dinâmica de fluidos da Baía de Bengala (BB), como resposta do oceano superficial a um ciclone tropical (CT). O modelo utiliza uma grade curvolinear ortogonal e 26 níveis-sigma, em conformidade com a topografia realística do fundo. O modelo foi forçado pelo vento, calor e salinidade superficial, com a finalidade de simular a resposta da BB durante um evento de ciclone. A fim de proporcionar um vórtice ciclônico realista como entrada para o modelo, um vórtice ciclônico sintético foi gerado e sobreposto aos campos de ventos oceânicos misturados QSCAT / NCEP. Os resultados obtidos mostraram resfriamento significativo da temperatura superficial do mar (TSM), em ambos os lados do rastro da tempestade. Esse resfriamento pode ser atribuído aos fortes ventos ciclônicos, à divergência de superfície e também à ressurgência. No entanto, no presente estudo, foi também observada uma característica menos comum, que é o viés para a esquerda no resfriamento da TSM devido a movimentação mais lenta do CT e deslocamento para o sul das correntes de contorno costeiras. Para a avaliação do desempenho do modelo SST, este foi comparado com a "Tropical Rainfall Measuring Mission (TRMM) Microwave Imager (TMI)" observada e que ocupou a SST. Além disso, não só o resfriamento da superfície do mar, mas também o aquecimento da subsuperfície, devido à subsidência intensa e ao jato costeiro paralelo à costa, foi observado pela modelagem. Igualmente, a variação da profundidade da camada mista (PCM) foi revelada pelo modelo. Ocorreu um aprofundamento da Camada Mista, devido à convergência do fluxo próximo da superfície na periferia do ciclone; no entanto, sob o centro do ciclone, ao longo da direcção da subida das isotermas, causada pela divergência de superfície e pela ressurgência, ocorre o empolamento da PCM. Correntes de superfície modeladas são comparadas com as correntes superficiais de 5 dias de intervalo, chamadas de OSCAR (Análises de Correntes Superficiais em Tempo Real), que embora não sendo de grande coerência, permitem que algumas características importantes, tais como valores elevados de correntes da camada limite, sejam capturados. No entanto, perto da superfície, o modelo reflete uma forte resposta assimétrica, tal como a presença de correntes divergentes na região oceânica; porém, quando o ciclone se aproxima da costa os padrões atuais não mostram o viés de direita, devido à interação costeira

Prioritized Service Scheme with QOS Provisioning in a Cloud Computing System

Cloud computing is a compilation of existing techniques and technologies, packaged within a new infrastructure paradigm that offers improved scalability, elasticity, business agility, faster startup time, reduced management costs, and just-in-time availability of resources. It is based on the pay as you use policy and virtual servers are used in this technology. This technology is capturing the market at a rapid rate and is an advancement over the distributed computing technology. There is a scheduling issue in this technology as in case of normal scheduling the service with the more burst time blocks the service of less burst time hence we need to prioritize the service in the way that every service gets equal opportunity to execute. A priority scheme is proposed in which the prioritized customers are categorized into different priority queues. These prioritized customers have guaranteed Quality of Service (QoS) by the cloud computing system in terms of less response time. The concept of selection probability is introduced according to which the cloud metascheduler chooses the next query for execution. The priority queues are modeled as M/M/1/K/K queues and an analytical model is developed for the calculation of selection probabilities. Two algorithms are proposed for explaining the processing at the users’ end and at the Cloud Computing server’s end. The results obtained are validated using the numerical simulations. DOI: 10.17762/ijritcc2321-8169.15024

Further Studies on Antioxidant Potential and Protection of Pancreatic β-Cells by Embelia ribes in Experimental Diabetes

This study was designed to examine the antioxidant defense by ethanolic extract of Embelia ribes on streptozotocin-(40 mg/kg, intravenously, single-injection) induced diabetes in Wistar rats. Forty days of oral feeding the extract (100 mg/kg and 200 mg/kg) to diabetic rats resulted in significant (P < .01) decrease in blood glucose, blood glycosylated haemoglobin, serum lactate dehydrogenase, creatine kinase, and increase in blood glutathione levels as compared to pathogenic diabetic rats. Further, the extract also significantly (P < .01) decreased the pancreatic thiobarbituric acid-reactive substances (TBARS) levels and significantly (P < .01) increased the superoxide dismutase, catalase, and glutathione levels as compared to above levels in pancreatic tissue of pathogenic diabetic rats. The islets were shrunken in diabetic rats in comparison to normal rats. In the drug-treated diabetic rats, there was expansion of islets. The results of test drug were comparable to gliclazide (25 mg/kg, daily), a standard antihyperglycemic agent. The study concludes that Embelia ribes enhances the antioxidant defense against reactive oxygen species produced under hyperglycemic condition and this protects β-cells against loss, and exhibit antidiabetic property