Maternal mortality in a tertiary care hospital: a five-year review

Background: This study was aimed at analyzing the maternal mortality ratio over five years, the causes leading to maternal deaths in a tertiary care hospital and factors which are preventable.Methods: The records of maternal death from August 2010 to July 2015 (5 years) were collected and analyzed. Various factors like maternal age, parity, literacy, place of residence, antenatal registration, admission-death interval, mode of delivery and causes of deaths were reviewed.Results: The mean maternal mortality ratio (MMR) was 1039. The direct causes of maternal mortality were hemorrhage (22.4%), eclampsia (21.2%), sepsis (18.78%) and amniotic fluid embolism (8.48%). Indirect obstetric deaths were due to hepatitis (10.9%), anemia (3.6%), respiratory diseases (6.06%), heart diseases (3.03%), CNS disease (5.45%).  Most of the deaths (69.7%) occurred in age group 20 and30 years. 63.6% were multigravida and 85.4% were unbooked cases.Conclusions: Antenatal care, screening and management of high risk pregnancies are most important to prevent complications and maternal deaths by timely detection and intervention

Evaluation of yield monitoring system installed on indigenous grain combine harvester for rice crop

Precision agriculture is a methodology to identify and exploit variability within an agricultural field.  In India, a yield is measured during marketing of harvested crop and as a gross yield of the land owned by the farmer.  The yield monitor mounted over grain combine harvester measures and records information such as grain flow, grain moisture, area covered and location.  An automated yield monitoring system consisting of a yield sensor, global positioning system (GPS), field computer with custom software was mounted on a self propelled indigenous grain combine harvester for real-time crop yield mapping along with moisture data.  By means of optical sensors (light emitter and detector), the height of the grain on the elevator paddles was measured and converted in the grain mass flow.  Three rice fields were harvested to evaluate the performance of the yield monitor for grain yield and moisture mapping of harvested grains.  The actual yield maps were generated by using Arc GIS software from the data collected for three different rice fields.  The total area harvested by using indigenous combine harvester fitted with yield monitor and moisture sensor was 0.84 ha comprising three fields (1, 2 and 3) having areas 0.3, 0.22 and 0.32 ha respectively.  On an average, yields for all the three fields (1, 2 and 3) were 4,325.91, 5,093.14 and 4,287.66    kg ha-1 with moisture content of 21.42%, 22.78% and 20.42% (wet basis) recorded respectively.  On an average, yield variations recorded for all the three fields (1, 2 and 3) were having 30.59%, 40.80% and 40.39% coefficient of variation respectively.  The minimum and maximum yields recorded within all the fields harvested were 577.08 and 7,661.48 kg ha-1 with an average yield of 4,287.66 kg ha-1 having 37.26% coefficient of variation (CV) in all the three fields.   Keywords: Combine harvester, precision agriculture, sensor; yield maps, yield monito

Attribute Based Coding, Review and Gap Analysis of Cotton Harvesting Processes and Machines

Mechanical cotton harvesters, i.e. strippers and pickers are commercially available, but these cannot be used for cotton harvesting from varieties presently grown in India due to design constraints and agronomic practices. Higher initial cost and field capacity make cotton harvesters unsuitable and unaffordable for small and medium farms. Hence, a comprehensive review of cotton harvesting mechanisms developed till date was carried out. Different attributes relating to problem have been expressed in matrix form to identify of crop and machine parameters which could be utilized by Researchers, Engineers and Manufacturers for development and refinement of mechanical cotton harvesters for small and medium farms. The matrix depicts on academic work of each paper and each attribute. Coding/grading of these attributes was done according to their importance in the research publications. Summation of coded attributes has been done publication-wise as well as category-wise so that the value of each attribute and each publication gets identified for the development of a need based mechanical cotton harvester. For publication-wise attribute coding, a total of 19 publications with 21 attributes were reviewed and related with the mechanical cotton harvesters. A publication with all the 21 selected attributes had been discussed in detail and was assigned a score of 105. Under the category-wise attribute coding, attributes such as crop variety, yield, row spacing, plant height and plant population were considered and assigned grade more than 20 as most of the authors discussed these attributes in their studies. Other parameters like limb length, plant canopy (spread width) along and across the rows, height of lower and upper boll were accorded less importance as their grade was less than 10 out of a total 95 score. Defoliant attributes were discussed in 14 out of 19 papers reviewed and had 28 grade points as compared to desiccant, which was discussed in only 2 papers and assigned a grade of 5 only. Under the machine parameters, type of mechanism was assigned a grade point i.e. 66 as mechanical harvester performance was mainly dependent on this attribute. So far, as the performance of harvester was concerned, various parameters like picking efficiency, trash content, lint turnout and losses were discussed in different studies.

A rare case of ruptured caesarean scar pregnancy

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. The incidence is approximately 1:2000 pregnancies and has potentially life-threatening complications. Ours is a rare case of scar ectopic pregnancy who had taken medical termination of pregnancy (MTP) kit while being unaware of her pregnancy location and presented with uterine rupture and hemoperitoneum. A 24-year-old female, P2L2A1, with previous two caesarean section (CS), presented with the complaint of bleeding per vaginum with acute pain abdomen and history of MTP kit intake at 7 weeks’ period of gestation (POG). She received symptomatic treatment at local hospital without any diagnosis being made but brought an ultrasound showing anterior myometrium defect with scar site hematoma and free fluid. She presented with moderate pallor, tachycardia and suprapubic tenderness. She was subsequently taken up for laparotomy in view of probable ruptured CSP. Intra-operatively, actively bleeding scar ectopic was seen with hemoperitoneum. The contents were scooped out and repair done with bilateral tubal ligation. She was resuscitated with adequate blood products. Embryo implantation in the region of a previous CS scar is rare and a delay in either diagnosis or treatment can have catastrophic complications like haemorrhage, rupture and significant maternal morbidity as seen in our case. Therefore, we should have a high index of suspicion of scar pregnancy especially in cases of previous CS so that timely intervention can be done preventing maternal morbidity. Unwarranted use of misoprostol can be deleterious when site of implantation is unknown, particularly in CSP

Wide resection and stabilization of ulnar stump by extensor carpi ulnaris for giant cell tumor of distal ulna: two case reports

The distal end of ulna is an extremely uncommon site for primary bone tumors in general and giant cell tumor in particular. Wide resection is usually indicated in such cases and at times it may be necessary to remove of a long segment of the distal ulna. Any ulnar resection proximal to the insertion of pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in diminution of forearm rotation and weakness with grasp. Stabilization of the ulnar stump after resection for a giant cell tumor was described by Kayias & Drosos. We are adding two more cases to the literature. Both patients had excellent functional outcome and there were no instances of recurrence at three years of follow-up

Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture   and   rapid   inclusion   of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups

Synthesis of 2-substituted-l-[(2'-carbo-xybiphenyl-4-yl) methyl]benzimidazoles

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DIGITAL SUBTRACTION ANGIOGRAPHY: PROBLEM SOLVING TOOL IN DECISION MAKING IN EQUIVOCAL CASES OF POLYTRAUMA

We are reporting a case of polytrauma having head injury and fracture in both bone lower limb, highlighting the importance of Digital Subtraction Angiography (DSA) in patient care and management and how important it is to be aware of normal anatomical variations. It can lead to an erroneous diagnosis and therefore change the entire management protocol of the patient. Polytrauma is an emergency , immediate and judicious intervention is the mainstay in patient's management