A comparative study of vaginal delivery and caesarean section in antepartum eclampsia at and beyond 34 weeks of gestation

Background: This study was done to compare maternal and fetal outcome in pregnancies after 34 weeks gestation complicated by antepartum eclampsia when terminated by caesarean section and by vaginal delivery. Methods: A comparative prospective study was done on 100 pregnant women with antepartum eclampsia at or beyond 34 weeks of gestational age from November 2019 to June 2021 at Gandhi Hospital, Secunderabad, Telangana. The patients were divided into two groups: CD group (who delivered by caesarean section) and VD group (who delivered by vaginal route). After history taking and examination, delivery was planned according to the gestational age, foetal condition and Bishop’s score. The associated indication for caesarean, induction delivery interval in vaginal deliveries, total blood loss was noted. Baby details were noted and were followed till discharge at hospital. Results: The incidence of caesarean section was 41% and that of vaginal delivery was 59%. Highest incidence of antepartum eclampsia was seen in the age group of 20-24 years and between 37-40 weeks. Most common indication of caesarean section was fetal distress (19%). The convulsion-delivery interval was less in CD group and it was statistically significant (p value 0.01). The incidence of live births, still births and IUD was better in the CD group than VD group (p value 0.02). Perinatal mortality was more in vaginal delivery group (27.64%) than in caesarean section group (12.19%). Maternal mortality was 1.7% in the VD group and nil in the CD group. Conclusions: The study reflected that both perinatal and maternal morbidity and mortality were found to be lesser in the CD group in comparison with the VD group. Thus, early decision for caesarean section especially when delivery is not anticipated within 6 hours of admission is essential in improving the perinatal and maternal outcome in eclampsia

Antibody Concentrations to A Beta 1-42 Monomer and Soluble Oligomers in Untreated and Antibody-Antigen-Dissociated Intravenous Immunoglobulin Preparations

Cognitive improvement in Alzheimer\u27s disease (AD) patients treated with intravenous immunoglobulin (IvIg) has been attributed to its antibodies to amyloid beta (A beta) We compared the concentrations of specific antibodies to soluble A beta 1-42 conformations, namely A beta 1-42 monomer and A beta 1-42 soluble oligomers, between three IvIg preparations. Gamunex, Gammagard. and Flebogamma. To determine specific antibody Concentrations to these A beta 1-42 conformations. nonspecific binding of the IvIg preparations to the An reverse sequence, A beta 42-1. was subtracted These antibodies were measured in untreated IvIg preparations and also after they were treated to dissociate antibody-antigen complexes. because this procedure has been reported to increase the detectable levels of serum anti-A beta antibodies. Antibody levels to A beta 1-42 monomer were significantly higher in untreated Gamunex than in the other two IvIg preparations, and antibody-antigen dissociation increased the measured anti-A beta monomer concentrations in Gamunex and Gammagard Dissociated Gamunex and Gammagard had higher anti-A beta monomer levels than Flebogamma. Generally similar results were found for antibodies to soluble A beta 1-42 oligomers. with the exception that after antibody-antigen dissociation, only Gammagard had significantly higher antibody levels than Flebogamma. These differences in antibody concentrations to A beta 1-42 conformations (particularly to A beta 1-42 soluble oligomers, thought to be the most neurotoxic conformation of soluble A beta) and the increased availability of these antibodies after antibody-antigen complex dissociation have important implications for IvIg treatment of AD patients

Agricultural by-products for phosphorous removal and recovery from water and wastewater: A green technology

© 2016 American Society of Civil Engineers. Phosphorus (P) is a critical nutrient for plant growth. The excessive amount of P in aquatic medium may originate from natural sources and/or artificial sources. This chapter discusses P removal/recovery from wastewater due to surface water quality deterioration and P rock reserves depletion. It focuses on both fundamental and applied aspects of this practice using agricultural waste based biosorbents (AWBs). Understanding the operation principles is expected to enable the application of AWBs in the future. Because of increasing concerns relevant to water quality deterioration and depletion of global P rock reserves, P removal/recovery recently has become a matter of interest. Even though various technologies are presently available, adsorption seems to have advantages when used for P recovery. Although AWBs in both natural and modified forms can be used for P removal, the low P uptake capacity of raw AWBs hinders their widespread application

Effects of External Beam Radiation on \u3ci\u3eIn Vitro\u3c/i\u3e Formation of Abeta1-42 Fibrils and Preformed Fibrils

Plaques containing fibrillar amyloid-beta (Abeta) are a characteristic finding in Alzheimer\u27s disease. Although plaque counts correlate poorly with the extent of cognitive deficits in this disorder, fibrillar Abeta can promote neuronal damage through a variety of mechanisms. External beam radiotherapy has been reported to be an effective treatment for tracheobronchial amyloidosis, in which amyloid is deposited as submucosal plaques and tumor-like masses in the trachea and/or bronchi. Radiotherapy\u27s effectiveness in this disorder is thought to be due to its toxicity to plasma cells, but direct effects of radiotherapy on amyloid may also be involved. On this basis, whole-brain radiotherapy has been suggested as a treatment for Alzheimer\u27s disease. The objective of this study was to determine the effects of external beam radiation on preformed Abeta1-42 fibrils and on the formation of these fibrils. Using the Thioflavin-T assay, no effects of radiation were found on either of these parameters. Our results in this in vitro study suggest that whole-brain irradiation is unlikely to directly reduce plaque counts in the Alzheimer\u27s disease brain. This treatment might still lower plaque counts indirectly, but any potential benefits would need to be weighed against its possible neurotoxic effects, which could induce further cognitive deficits

Exposure to Weight Management Counseling Among Students at 8 U.S. Medical Schools

INTRODUCTION: Clinical guidelines support physician intervention consistent with the Ask, Advise, Assess, Assist, Arrange framework for adults who have obesity. However, weight management counseling curricula vary across medical schools. It is unknown how frequently students receive experiences in weight management counseling, such as instruction, observation, and direct experience. METHODS: A cross-sectional survey, conducted in 2017, of 730 third-year medical students in 8 U.S. medical schools assessed the frequency of direct patient, observational, and instructional weight management counseling experiences that were reported as summed scores with a range of 018. Analysis was completed in 2017. RESULTS: Students reported the least experience with receiving instruction (6.5, SD=3.9), followed by direct patient experience (8.6, SD=4.8) and observational experiences (10.3, SD=5.0). During the preclinical years, 79% of students reported a total of \u3c /=3 hours of combined weight management counseling instruction in the classroom, clinic, doctor\u27s office, or hospital. The majority of the students (59%-76%) reported never receiving skills-based instruction for weight management counseling. Of the Ask, Advise, Assess, Assist, Arrange framework, scores were lowest for assisting the patient to achieve their agreed-upon goals (31%) and arranging follow-up contact (22%). CONCLUSIONS: Overall exposure to weight management counseling was less than optimal. Medical school educators can work toward developing a more coordinated approach to weight management counseling. Inc

Exposure to environmentally persistent free radicals during gestation lowers energy expenditure and impairs skeletal muscle mitochondrial function in adult mice

© 2016 the American Physiological Society. We have investigated the effects of in utero exposure to environmentally persistent free radicals (EPFRs) on growth, metabolism, energy utilization, and skeletal muscle mitochondria in a mouse model of diet-induced obesity. Pregnant mice were treated with laboratory-generated, combustion derived particular matter (MCP230). The adult offspring were placed on a high-fat diet for 12 wk, after which we observed a 9.8% increase in their body weight. The increase in body size observed in the MCP230-exposed mice was not associated with increases in food intake but was associated with a reduction in physical activity and lower energy expenditure. The reduced energy expenditure in mice indirectly exposed to MCP230 was associated with reductions in skeletal muscle mitochondrial DNA copy number, lower mRNA levels of electron transport genes, and reduced citrate synthase activity. Upregulation of key genes involved in ameliorating oxidative stress was also observed in the muscle of MCP230-exposed mice. These findings suggest that gestational exposure to MCP230 leads to a reduction in energy expenditure at least in part through alterations to mitochondrial metabolism in the skeletal muscle

Variability and genetic divergence in paprika (Capsicum annuum L.) 1

Ninety four paprika (Capsicum annuum) accessions were evaluated for 17 characters forvariability, heritability, genetic advance and genetic divergence at Lam, Guntur (AndhraPradesh). Higher phenotypic and genotypic coefficient of variation (PCV and GCV) andheritability coupled with high genetic advance was observed for number of fruits plant-1,fresh fruit yield plant-1, dry fruit yield plant-1, 100 seed weight, number of seeds fruit-1 andcapsanthin, capsaicin and oleoresin contents indicating the higher magnitude of variabilityfor these traits and consequently more scope for their improvement through selection. Plantheight, plant spread and fruit diameter exhibited moderate PCV and GCV estimates suggestingthe possible role of environment in expression of these characters. Cluster analysis throughMahalanobis D2 analysis classified the 94 genotypes into 10 clusters indicating considerablegenetic diversity in the material studied. &nbsp

Acute lower limb compartment syndrome after Cesarean section: a case report

Abstract: Introduction Acute compartment syndrome of the lower limb is a rare but severe intra- and post-partum complication. Prompt diagnosis is essential to avoid permanent functional restriction or even the loss of the affected limb. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors can be helpful. Case presentation We present the case of a 32-year-old Caucasian woman with acute post-partum compartment syndrome. Conclusion: Acute compartment syndrome is an important differential diagnosis for the sudden onset of intra- or post-partum lower-limb pain. Predisposing factors for the manifestation of acute compartment syndrome in an obstetric environment are augmented intra-partum blood loss, prolonged hypotensive episodes and the use of oxytocin to support or induce labor because of its vasoconstrictive properties. Treatment is prompt surgical decompression by performing fasciotomy in any affected muscular compartments

Teaching Medical Students to Help Patients Manage Their Weight: Outcomes of an Eight-School Randomized Controlled Trial

BACKGROUND: Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts. OBJECTIVE: To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change. DESIGN: A pair-matched, group-randomized controlled trial (2015-2020) included students enrolled in eight U.S. medical schools randomized to receive either multi-modal weight management education (MME) or traditional weight management education (TE). SETTING/PARTICIPANTS: Students from the class of 2020 (N=1305) were asked to participate in an objective structured clinical examination (OSCE) focused on weight management counseling and complete pre and post surveys. A total of 70.1% of eligible students (N=915) completed the OSCE and 69.3% (N=904) completed both surveys. INTERVENTIONS: The MME implemented over three years included a web-based course, a role-play classroom exercise, a web-patient encounter with feedback, and an enhanced clerkship experience with preceptors trained in weight management counseling (WMC). Counseling focused on the 5As (Ask, Advise, Assess, Assist, Arrange) and patient-centeredness. MEASUREMENTS: The outcome was student 5As WMC skills assessed using an objective measure, an OSCE, scored using a behavior checklist, and a subjective measure, student self-reported skills for performing the 5As. RESULTS: Among MME students who completed two of three WMC components compared to those who completed none, exposure was significantly associated with higher OSCE scores and self-reported 5A skills. LIMITATIONS: Variability in medical schools requiring participation in the WMC curriculum. CONCLUSIONS: This trial revealed that medical students struggle with delivering weight management counseling to their patients who have overweight or obesity. Medical schools, though restrained in adding curricula, should incorporate should incorporate multiple WMC curricula components early in medical student education to provide knowledge and build confidence for supporting patients in developing individualized plans for weight management. NIH TRIAL REGISTRY NUMBER: R01-194787

NaxD is a deacetylase required for lipid A modification and Francisella pathogenesis

Modification of specific Gram-negative bacterial cell envelope components, such as capsule, O-antigen and lipid A, are often essential for the successful establishment of infection. Francisella species express lipid A molecules with unique characteristics involved in circumventing host defences, which significantly contribute to their virulence. In this study, we show that NaxD, a member of the highly conserved YdjC superfamily, is a deacetylase required for an important modification of the outer membrane component lipid A in Francisella. Mass spectrometry analysis revealed that NaxD is essential for the modification of a lipid A phosphate with galactosamine in Francisella novicida, a model organism for the study of highly virulent Francisella tularensis. Significantly, enzymatic assays confirmed that this protein is necessary for deacetylation of its substrate. In addition, NaxD was involved in resistance to the antimicrobial peptide polymyxin B and critical for replication in macrophages and in vivo virulence. Importantly, this protein is also required for lipid A modification in F. tularensis as well as Bordetella bronchiseptica. Since NaxD homologues are conserved among many Gram-negative pathogens, this work has broad implications for our understanding of host subversion mechanisms of other virulent bacteria