Long term clinical outcome of intra caesarean intrauterine contraceptive device insertion

Background: Adequate spacing following caesarean section prior to next pregnancy will decrease maternal and neonatal complications. Unmet need of contraception is still high in our country. Motivating women for intra caesarean copper T insertion will decrease the incidence of unintended pregnancies. Postpartum intra uterine contraceptive device (PPIUCD) insertion is an effective, long-term, reversible, nonhormonal contraceptive, best suited for Indian women. This study aims to evaluate long term complications like bleeding, pain, expulsion rate, perforation, infection, missing strings and continuation rate.Methods: This prospective observational study was carried out in a tertiary care hospital in Chennai, between January 2012-June 2015. CuT 380A was inserted immediately following placental delivery in caesarean section. They were followed up at the time of discharge, at 6 weeks, then at 6 monthly intervals till 30months.Results: A total of 235 PPIUCD acceptors were followed up for 30 months. Most of our acceptors are primipara group (n=156, 66.4%). Continuation rate is high 84.7% (n=199) at the end of 30 months. Expulsion rate was 2.55% (n=6), bleeding in 8.5% (n=20), pain in 8.9% (n=21) and infection in 0.85% (n=2) of acceptors. Removal rate at 30 months was 12.7% (n=30), majority of the removal was for opting to go for permanent method of sterilization (n=117, 7.2%), followed by planning next pregnancy (n=6, 2.55%). Pain was the cause for removal in only 0.67%, bleeding in 1.67%. Missing strings were observed in 11.9% (n=28), of which ultrasound confirmed in situ uterine cavity location in 22 acceptors.Conclusions: Intra caesarean IUCD insertion is a safe and effective method of contraception for spacing with high continuation rate, low expulsion and complication rates

Clinical profile and pregnancy outcome following tubal recanalisation

Background: Female sterilization by tubal ligation accounts for 36% of all methods of family planning used in our country. Almost half of tubal ligations are done in women younger than 25 years. These women want reversal of tubectomy subsequently, in circumstances like death of children, remarriage. This study aims to evaluate various factors affecting the outcome of pregnancies following microsurgical tubal recanalisation.Methods: It is a prospective observational study carried out at Govt Kilpauk Medical College for a total number of 50 patients who have undergone tubal recanalisation during 2011 and 2012. They were followed up till December 2016.Results: 84% of women (n-42) opted for recanalisation were in young reproductive age (<30 years) group. Conception rate was higher in younger age group (52.9% in 21-25 years). Death of children (n-37, 74%) and remarriage (n-12, 24%) were the common indications for tubal recanalisation. Outcome is better if reversal surgery is done within 4 years after sterilization (69.6%, n-16 out of 23) than after 4 years (30.4%, n-7out of 23). Conception rate (55.3%, n-21) was higher and statistically significant in subjects with final length of tube more than 4 cms (P value -0.0193). Conception rate was higher within 1 year of recanalisation (n-13, 26%), followed by 16% (n-8) in 2nd year and statistically significant (p- 0.00001). Overall pregnancy rate in our study was 46% (n-23). Out of the 23 women who conceived, 14 (61%) resulted in live birth, 3 (13%) abortions and the remaining 6(26%) had ectopic pregnancies.Conclusions: Proper selection of patients and meticulous tuboplasty technique can yield successful pregnancy outcome comparable to ART

An analytical cross sectional study on hypothyroidism in pregnancy, its maternal and fetal outcome

Background: Hypothyroidism is associated with maternal and fetal complications. This study aims to evaluate the prevalence, maternal and fetal outcome in hypothyroidism. Objective of this study was to determine whether thyroid function test can be recommended as a universal or selective screening in pregnancy.Methods: An analytical cross-sectional study with internal comparison carried out at Govt. Kilpauk Medical College & Hospital from September 2017 to July 2018 for antenatal mothers in third trimester. Serum TSH and freeT3, T4 in case of abnormal TSH were measured, grouped into subclinical and overt hypothyroidism and were treated with Levothyroxine. Six-week follow-up with TSH, pregnancy complications were observed.Results: 932 pregnant mothers were followed up. Prevalence of hypothyroidism was 10.5% (n = 98). Among the hypothyroid 62.24% (n = 61) had subclinical and 37.76% (n = 37) had overt hypothyroidism. The prevalence of anaemia was 35% in overt and 15% in subclinical hypothyroid group (p = 0.019). Preeclampsia is reported in 49% of overt and 16% of subclinical hypothyroid group (p = <0.001), statistically significant. Eclampsia was noted in 1 (1.64%) overt hypothyroid patient. Abruptio placenta was observed in 1 subclinical and 4 overt hypothyroid patients (5.1%). The incidence of preterm labour in this study subjects was 38% in overt and 20% in subclinical hypothyroid group (p = 0.048). The incidence of LBW fetus was 41% in overt hypothyroid and 21% in subclinical hypothyroid group (p = 0.041). The incidence of complication in this study was 41% in subclinical and 78% in overt hypothyroid group (p = <0.001).Conclusions: Early screening, adequate treatment and follow up will bring down maternal and fetal complications in hypothyroidism

Tailored fuel injection within a Mach 12 shape transitioning scramjet

Three-dimensional computational fluid dynamic simulations were performed for the Mach 12 Rectangular-to-Elliptical Shape-Transitioning scramjet. Present injector arrangements at the combustor entrance displayed low jet penetration, resulting in a oxygen-based combustion efficiency of 84.9%. It is proposed to convert three cowl-side injectors into one larger injector located further upstream. To support this, injector configurations were investigated computationally, taking injectors optimised for penetration at lower Mach numbers, and evaluating their performance at higher Mach number flight conditions. It was determined that reduced performance of these optimised injectors was encountered at scramjet flight conditions above their design point, with circular injectors at equal or greater injection angles displaying greater penetration and mixing capabilities

Performance of high mach number scramjets - Tunnel vs flight

While typically analysed through ground-based impulse facilities, scramjets experience significant heating loads in flight, raising engine wall temperatures and the fuel used to cool them beyond standard laboratory conditions. Hence, the present work numerically compares an access-to-space scramjet's performance at both these conditions. The Mach 12 Rectangular-to-Elliptical Shape-Transitioning scramjet flow path is examined via three-dimensional and chemically reacting Reynolds-averaged Navier-Stokes solutions. Flight operation is modelled through 800 K and 1800 K inlet and combustor walls respectively, while fuel is injected at both inlet- and combustor-based stations at 1000 K stagnation temperature. Room temperature walls and fuel plena model shock tunnel conditions. Mixing and combustion performance indicates that while flight conditions promote rapid mixing, high combustor temperatures inhibit the completion of reaction pathways, with reactant dissociation reducing chemical heat release by 16%. However, the heated walls in flight ensured 28% less energy was absorbed by the walls. While inlet fuel injection promotes robust burning of combustor-injected fuel, premature ignition upon the inlet in flight suggests these injectors should be moved further downstream. Coupled with counteracting differences in heat release and loss to the walls, the optimal engine design for flight may differ considerably from that which gives the best performance in the tunnel

Role of Nanoparticles in Environmental Remediation: An Insight into Heavy Metal Pollution from Dentistry

Environmental damage is without a doubt one of the most serious issues confronting society today. As dental professionals, we must recognize that some of the procedures and techniques we have been using may pose environmental risks. The usage and discharge of heavy metals from dental set-ups pollute the environment and pose a serious threat to the ecosystem. Due to the exclusive properties of nanosized particles, nanotechnology is a booming field that is being extensively studied for the remediation of pollutants. Given that the nanoparticles have a high surface area to volume ratio and significantly greater reactivity, they have been greatly considered for environmental remediation. This review aims at identifying the heavy metal sources and their environmental impact in dentistry and provides insights into the usage of nanoparticles in environmental remediation. Although the literature on various functions of inorganic nanoparticles in environmental remediation was reviewed, the research is still confined to laboratory set-ups and there is a need for more studies on the usage of nanoparticles in environmental remediation.</jats:p

Clinical profile and pregnancy outcome following tubal recanalisation

Background: Female sterilization by tubal ligation accounts for 36% of all methods of family planning used in our country. Almost half of tubal ligations are done in women younger than 25 years. These women want reversal of tubectomy subsequently, in circumstances like death of children, remarriage. This study aims to evaluate various factors affecting the outcome of pregnancies following microsurgical tubal recanalisation.Methods: It is a prospective observational study carried out at Govt Kilpauk Medical College for a total number of 50 patients who have undergone tubal recanalisation during 2011 and 2012. They were followed up till December 2016.Results: 84% of women (n-42) opted for recanalisation were in young reproductive age (&lt;30 years) group. Conception rate was higher in younger age group (52.9% in 21-25 years). Death of children (n-37, 74%) and remarriage (n-12, 24%) were the common indications for tubal recanalisation. Outcome is better if reversal surgery is done within 4 years after sterilization (69.6%, n-16 out of 23) than after 4 years (30.4%, n-7out of 23). Conception rate (55.3%, n-21) was higher and statistically significant in subjects with final length of tube more than 4 cms (P value -0.0193). Conception rate was higher within 1 year of recanalisation (n-13, 26%), followed by 16% (n-8) in 2nd year and statistically significant (p- 0.00001). Overall pregnancy rate in our study was 46% (n-23). Out of the 23 women who conceived, 14 (61%) resulted in live birth, 3 (13%) abortions and the remaining 6(26%) had ectopic pregnancies.Conclusions: Proper selection of patients and meticulous tuboplasty technique can yield successful pregnancy outcome comparable to ART