Aggressive Versus Expectant Management of Severe Preeclampsia Remote from Term 28-34 Weeks.

INTRODUCTION: Preeclampsia is a multisystem disorder characterised by raised blood pressure and proteinuria. It complicates 5-8% of pregnancy and is a major cause of maternal and perinatal morbidity and mortality. (ACOG 2002², Sibai et al 1997 (39) Traditionally approach of balancing the interests of the mother with those of the fetus has been adopted in the management of preterm pregnancies with mild preeclampsia. Severe preeclampsia conversely has been delivered without delay regardless of fetal consideration. With improved methods of monitoring maternal and fetal well being, several investigators begun to challenge the traditional view that women with severe preeclampsia need be delivered expeditiously. Recent approach advocates conservative management in a selected group of women with severe preeclampsia remote from term with the aim of improving perinatal outcome without compromising maternal safety. AIM OF THE STUDY: 1. To compare the merits and demerits of aggressive and expectant management of women with severe Preeclampsia remote from term 28 – 34 weeks. 2. To determine which is more beneficial by comparing perinatal and maternal outcome by statistical analysis by Chi square test. MATERIAL AND METHODS: Study design : Prospective. Study period : Sep.2003 – Aug 2005. Sample: Group A: - Patients of severe PE remote from term 28 34 weeks treated aggressively that is glucocorticoid therapy followed by delivery in 48 hrs. All patients who delivered within 96 hrs of admission were noted. Group B: - Patients of the same group treated expectantly i.e glucocorticoid therapy, intensive maternal and fetal monitoring followed by delivery only for specific maternal or fetal indication beyond 96hours. Sample size : 97 patients of group A who delivered after 48hours of glucocorticoid therapy and 92 patients of groupB were compared. SELECTION CRITERIA - Inclusion Criteria : All subjects had 1) GA 28 - 34 weeks. 2) Severe pre eclampsia defined as i) Blood pressure > 160/110 with proteinuria> 2+, ii. Blood pressure > 150/100 with proteinuria >3+, iii.Blood pressure > 140/90 with proteinuria with c/o Headache or oliguria. Exclusive Criteria : 1. Women with medical complications, 2. Rupture of membrane, 3. Preterm labour, 4. Multifetal gestation, 5. Fetal compromise/ fetal death, 6. Platelet count < 1, 00,000/ Mic.L or HELLP, 7.Eclampsia, 8.Fetal congenital mal formation. Babies born without completing steroids are not compared with exp. Group. • Severe preeclampsia contributes 1% of all deliveries. In our study there were 259 patients of severe preeclampsia remote from term. Among them 189 patients who had full dose of steroids were compared. • Most of them were primis. • Most of them were in age group 25 to 34 years. • Mean gestational age on admission was 31 weeks. • 36% had recurrent preeclampsia. • 15.8% (29) patients had family history of preeclampsia. • Mean body mass index was 27.4. • Mean systolic BP 160 mmHg and mean diastolic BP being 106 mmHg. • Most of them needed 1000 – 1500 mg of alpha methyl dopa and 15-20mg of nifedipine for BP control. • Most patient had normal fundus. • Major maternal complications were higher in the expectant group, proved to be statistically non significant. 4 Patients had HELLP. 8 Patients had ABRUPTION. • 1 Needed renal dialysis in expectant group. There was no Maternal death and no eclampsia in both the groups. • Most of them delivered by 8-11hrs by inducing labor. • 65% terminated for maternal indication 35% for fetal indication. • LSCS rate was higher in expectant group (47.8% vs 15.5%) But this was mainly contributed by post cesarean pregnancy in expectant group. • Perinatal loss was significantly lower in expectant group 30.4% vs 55.7% proved to the statistically significant P (<0.001). • Perinatal loss is not influenced by cesarean section in expectant group as 42.8% perinatal death was contributed by LSCS and 57.2% by vaginal delivery statistically not significant. • Expectant group had higher birth weight than aggressive significant. 51% had birth weight > 1.5kg maximum being 2.4kg • Mean birth weight being 1.58kg. • Mean gestational age at delivery 32weeks. • Mean prologation of pregnancy is 8.6 days. • Perinatal mortality was higher in the patients delivered <48hrs of steroids. • Expectant group had relativety low admission of babies to NICU (92% vs 100%), lower mean stay of hospitalization (8 days vs 14 days ). • Babies in expectant group had higher survival rate (74.4% vs 55.8%). CONCLUSION: The conservative approach to the management of severe preclampsia remote from term results in a good obstetric outcome for most fetuses, in view of 1. Higher birth weight, 2. Lower perinatal mortality, 3. Lesser neonatal complications but this must be balanced against the significant risk of morbidity to the mothers. The success rate of expectant management will depend on both fetal gestational age and maternal and fetal conditions at the time of hospitalization. Since maternal and perinatal complications are significantly increased in these patients, expectant management should be carried out in well selected patients only at tertiary centers with adequate maternal and neonatal intensive care facilities. Finally patients with preeclampsia are at increased risk for recurrence of preeclampsia in subsequent pregnancies

Using Attribute-Based Access Control, Efficient Data Access in the Cloud with Authorized Search

The security and privacy issues regarding outsourcing data have risen significantly as cloud computing has grown in demand. Consequently, since data management has been delegated to an untrusted cloud server in the data outsourcing phase, data access control has been identified as a major problem in cloud storage systems. To overcome this problem, in this paper, the access control of cloud storage using an Attribute-Based Access Control (ABAC) approach is utilized. First, the data must be stored in the cloud and security must be strong for the user to access the data. This model takes into consideration some of the attributes of the cloud data stored in the authentication process that the database uses to maintain data around the recorded collections with the user\u27s saved keys. The clusters have registry message permission codes, usernames, and group names, each with its own set of benefits. In advance, the data should be encrypted and transferred to the service provider as it establishes that the data is still secure. But in some cases, the supplier\u27s security measures are disrupting. This result analysis the various parameters such as encryption time, decryption time, key generation time, and also time consumption. In cloud storage, the access control may verify the various existing method such as Ciphertext Policy Attribute-Based Encryption (CP-ABE) and Nth Truncated Ring Units (NTRU). The encryption time is 15% decreased by NTRU and 31% reduced by CP-ABE. The decryption time of the proposed method is 7.64% and 14% reduced by the existing method

Effect of Substitution of Hydrogenated Oil by a Mixture of Groundnut Oil and Hydrogenated Oil

The use of a mixture of 60% groundnut oil and 40% hydrogenated oil in the peace time Army ration, has been found to maintain the serum lipids at a lower level and improve the physical efficiency of albino rats

Structural aberrations in fluorosed human teeth: Biochemical and scanning electron microscopic studies

The present investigation was carried out to provide biochemical and ultrastructural evidences on the aberrations that appear in teeth in human Dental Fluorosis (DF), a condition caused by excess intake of fluoride. Human fluorosed teeth were obtained from the OPD of Madras Dental College, Chennai. Normal tooth samples were also collected from patients who opted for denture. The samples were investigated for fluoride and calcium contents, besides the tooth surfaces were examined under scanning electron microscope to assess the morphological aberrations. An increase in fluoride content and decrease in calcium content in fluorosed human teeth were observed when compared to the control. The scanning electron micrographs of the enamel surface of fluorosed human teeth show pitted, uneven and rough surfaces. Cracks and fissures were also observed on the enamel surface of fluorosed teeth. The present study provides evidence to suggest that pitting, perforation and structural alterations in DF are the result of impaired enamel mineralization

Association Study of Candidate Gene Polymorphisms and Obesity in a Young Mexican-American Population from South Texas

Background and Aims Obesity is increasingly a health problem and a risk factor for diabetes in young Mexican-American populations. Genetic association studies in older, mostly non-Hispanic populations have reported that polymorphisms in the candidate genes HSD11B1, CRP, ADIPOQ, PPARG, ANKK1, ABCC8 and SERPINF1 are associated with obesity or diabetes. We analyzed the polymorphisms rs846910, rs1205, rs1501299, rs1801282, rs1800497, rs757110 and rs1136287in these candidate genes, for association with obesity and metabolic traits in a young Mexican-American population from south Texas. Methods Genotyping of the seven common SNPs were performed by allelic discrimination assays in 448 unrelated Mexican Americans (median age = 16 years) from south Texas. χ2 tests and regression analyses using additive models were used for genetic association analyses adjusting for covariates; p values were corrected for multiple testing by permutation analyses. Results rs1800497 (ANKK1) shows association with waist circumference (p = 0.009) and retains the association (p = 0.03) after permutation testing. Analysis of metabolic quantitative traits shows that rs846910 (HSD11B1) was associated with HOMA-IR (p = 0.04) and triglycerides (p = 0.03), and rs1205 (CRP) with HOMA-IR (p = 0.03) and fasting glucose levels (p = 0.007). However, the quantitative traits associations are not maintained after permutation analysis. None of the other SNPs in this study showed associations with obesity or metabolic traits in this young Mexican-American population. Conclusions We report a potential association between rs1800497 (linked to changes in brain dopamine receptor levels) and central obesity in a young Mexican-American population

Small Heat Shock Protein αA-Crystallin Prevents Photoreceptor Degeneration in Experimental Autoimmune Uveitis

The small heat shock protein, αA-crystallin null (αA−/−) mice are known to be more prone to retinal degeneration than the wild type mice in Experimental Autoimmune Uveoretinitis (EAU). In this report we demonstrate that intravenous administration of αA preserves retinal architecture and prevents photoreceptor damage in EAU. Interestingly, only αA and not αB-crystallin (αB), a closely related small heat shock protein works, pointing to molecular specificity in the observed retinal protection. The possible involvement of αA in retinal protection through immune modulation is corroborated by adaptive transfer experiments, (employing αA−/− and wild type mice with EAU as donors and Rag2−/− as the recipient mice), which indicate that αA protects against the autoimmune challenge by modulating the systemic B and T cell immunity. We show that αA administration causes marked reduction in Th1 cytokines (TNF-α, IL-12 and IFN-γ), both in the retina and in the spleen; notably, IL-17 was only reduced in the retina suggesting local intervention. Importantly, expression of Toll-like receptors and their associated adaptors is also inhibited suggesting that αA protection, against photoreceptor loss in EAU, is associated with systemic suppression of both the adaptive and innate immune responses

Implementation of 3 T Lactate-Edited 3D 1H MR Spectroscopic Imaging with Flyback Echo-Planar Readout for Gliomas Patients

The purpose of this study was to implement a new lactate-edited 3D 1H magnetic resonance spectroscopic imaging (MRSI) sequence at 3 T and demonstrate the feasibility of using this sequence for measuring lactate in patients with gliomas. A 3D PRESS MRSI sequence incorporating shortened, high bandwidth 180° pulses, new dual BASING lactate-editing pulses, high bandwidth very selective suppression (VSS) pulses and a flyback echo-planar readout was implemented at 3 T. Over-prescription factor of PRESS voxels was optimized using phantom to minimize chemical shift artifacts. The lactate-edited flyback sequence was compared with lactate-edited MRSI using conventional elliptical k-space sampling in a phantom and volunteers, and then applied to patients with gliomas. The results demonstrated the feasibility of detecting lactate within a short scan time of 9.5 min in both phantoms and patients. Over-prescription of voxels gave less chemical shift artifacts allowing detection of lactate on the majority of the selected volume. The normalized SNR of brain metabolites using the flyback encoding were comparable to the SNR of brain metabolites using conventional phase encoding MRSI. The specialized lactate-edited 3D MRSI sequence was able to detect lactate in brain tumor patients at 3 T. The implementation of this technique means that brain lactate can be evaluated in a routine clinical setting to study its potential as a marker for prognosis and response to therapy