Screening for perceived stress among pregnant women availing antenatal care at a tertiary care teaching institution in Kerala, India

Background: Stress during pregnancy can have serious adverse outcomes on the mother, the foetus and the new-born. It can lead to low-birth-weight, preterm births and neuro-psychological effects such as anxiety and depression during pregnancy and puerperium. This cross-sectional research aims to assess the severity of stress among postnatal women in Kerala. This study analysed socio-demographic, obstetric, family dynamics, neonatal characteristics and psychiatric determinants of postpartum stress using perceived stress scale (PSS) among postnatal women in a tertiary hospital in Kerala state, India.Methods: 119 women between 2 to 6 weeks of postpartum period were subjected to a pre-tested pre-structured standard questionnaire. Terminal illness, still birth delivery and comorbid psychiatric illness was excluded. Screening and diagnosis of postpartum stress was done based on perceived stress scale (PSS) and graded as mild 0-13, moderate 14-26, severe 27-40.Results: Study findings indicated a statistically significant association between postpartum stress and risk factors such as unplanned/unwanted pregnancy. The mean age of women was 27±4.8 years. Support from spouse and in-laws was a negative predictor of developing both postnatal stress and depression. Family income, education of couple and husbands’ occupations were non-determinant factors (p>0.05) in this study. Psychiatric illness in the family and past history of psychiatric illness also contributed to postnatal stress. The most important variable which influenced perceived stress during pregnancy was lengthier NICU stay. Even breastfeeding problems and associated neonatal issues worsened the stress scales significantly in the immediate postnatal period.Conclusions: This research concluded that stress detection and timely counselling along with mental and physical support will mitigate stress and postpartum depression

Determinants and outcomes of caesarean delivery: elective versus emergency in a tertiary care teaching institute in Kerala, India

Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The purpose was to analyse the determinants and maternofoetal outcomes in elective versus emergency caesarean sections in a tertiary care centre.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018), were studied in Travancore Medical College in Kerala, India. Indications of caesarean, whether emergency or elective, medical morbidities, Gestational age at decision, birthweights and extended hospital stay and new-borns needed to resuscitate were looked into. The data was collected and analysed from the hospital registry.Results: Out of the 378 selected patients, 95 patients in group of elective and 283 emergency caesarean section were studied. The indications of emergency caesarean sections were failed induction, non-progression of labour, CPD, Previous caesarean in labour, foetal distress. The most frequent indicator for elective lower segment caesarean section (LSCS) was patient with previous LSCS not willing for vaginal birth, followed by breech presentation and high risk pregnancy ( BOH and ART). Younger mothers, gestational age remote from term, low-birth weight, and extended hospital stay were statistically significant in mothers undergoing emergency caesarean delivery. Fever, urinary tract infections, need for maternal and neonatal ventilation, blood transfusion, scar dehiscence were more common in the emergency caesarean group.Conclusions: The antenatal morbidity, low birth weights, decision taken preterm for salvaging the baby, postoperative complications and extended stay were more in the emergency caesarean when compared to elective caesarean

Prevalence and determinants of postnatal depression in a tertiary care teaching institute in Kerala, India

Background: Pregnancy and childbirth produce a variety of physiological, psychological and social consequences. Attitudes toward pregnancy and childbirth vary from culture to culture. Prevalence estimates range from 13 to 19% in resource-rich settings and 11 to 42% in resource- limited settings PND has a significant impact on the mother, the family, her partner and mother-infant interaction. This research aims to aid the early diagnosis of postnatal depression and the socio-demographic, obstetric, family dynamics, neonatal characteristics and psychiatric determinants of depression using EPDS among postnatal women in a tertiary hospital in Kerala state, India.Methods: 119 women between 2 to 6 weeks of postpartum period were subjected to a pre-tested pre-structured standard questionnaire. Diagnosis of depression was made using the Edinburgh postnatal depression scale. Possible depression is values >13 or more are invariably associated with depression.Results: Young age at marriage (p-value 0.022), love marriage (p-value 0.040) and low social support inadequate relationship with the in-laws was significantly associated with PND (p-0.003). Low birth weight was a significant determinant of PND (p-value-0.018). Gender of the new-born, fear and preference towards any particular gender and order of female child in multiparous woman had no association in determining postnatal depression. Childcare stress (p-value-0.011), psychiatry history in family and personal history of depression and mothers with low self-esteem (p-value-0.001) had odds of developing postnatal depression in the study.Conclusions: Early screening of the women and counselling of women and their family will reduce the maternal morbidity and adverse child outcomes

Development of a ROT22 - DATAMAP interface

This report (Contract NAS2-10331- Mod 10), outlines the development and validation of an interface between the three-dimensional transonic analysis program ROT22 and the Data from Aeromechanics Test and Analytics-Management and Analysis Package (DATAMAP). After development of the interface, the validation is carried out as follows. First, the DATAMAP program is used to analyze a portion of the Tip Aerodynamics and Acoustics Test (TAAT) data. Specifically, records 2872 and 2873 are analyzed at an azimuth of 90 deg, and record 2806 is analyzed at 60 deg. Trim conditions for these flight conditions are then calculated using the Bell performance prediction program ARAM45. Equivalent shaft, pitch, and twist angles are calculated from ARAM45 results and used as input to the ROT22 program. The interface uses the ROT22 results and creates DATAMAP information files from which the surface pressure contours and sectional pressure coefficients are plotted. Twist angles input to ROT22 program are then iteratively modified in the tip region until the computed pressure coefficients closely match the measurements. In all cases studied, the location of the shock is well predicted. However, the negative pressure coefficients were underpredicted. This could be accounted for by blade vortex interaction effects

Analysis of caesarean delivery using Robson ten group classification system at a tertiary care teaching institute in Kerala, India

Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The Robson classification, appreciated by WHO in 2014 and FIGO in 2016 is widely accepted, risk-based, ten-group classification system (TGCS) developed specifically to assess caesarean section rates. The aim of this study was to know the rate of Caesarean section in present hospital, to analyse the Caesarean sections based on Robson’s classification and to determine the contribution and significance of each group on the overall number of Caesarean sections.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018) in Travancore Medical College Hospital in South Kerala India.Results: Group 5 (previous LSCS, single, cephalic >37 weeks) made the greatest contribution to the Caesarean section rate (27.24%). The second highest contributor was Group 2 (Nulliparous, singleton, cephalic, >37 weeks induced labour or caesarean section before labour followed by Group 10 (all single cephalic <36 weeks including previous CS) 18.78%.Conclusions: Limiting the CS rate in low-risk pregnancies is key to lowering the trend of increased CS. If TGCS is used uniformly, CS rates can be compared over time and between units, both nationally and internationally

Emergency obstetric care among referrals in more than 24 weeks gestation at a tertiary care teaching institution in Kerala, India

Background: One of the biggest barriers confronting efforts to reduce maternal mortality through increased skilled delivery is access to emergency obstetric care. This study aimed to look into the profile of emergency obstetric referrals. Referral-decision interval, reasons and morbidities of referral were analysed and their neonatal outcomes assessed.Methods: This observational study reviewed 90 emergency obstetric referrals over 3 years from June 2013 to February 2016.Results: In-labour referrals constituted the majority of emergency obstetric referrals. Preterm obstetric referrals needed emergency interventions in view of medical/obstetric indications and it was statistically significant. Referral- decision and referral-arrival interval was significant in emergency group (p-value-0.001). Babies born to mothers who were obstetric emergency referrals had extended NICU stay (p-value-0.001). There was a maternal death and four near-misses in this research.Conclusions: Timely decisions taken during interhospital emergency referrals resulted in better perinatal outcomes by prompt maternal interventions

Re-equilibration after quenches in athermal martensites:Conversion-delays for vapour to liquid domain-wall phases

Entropy barriers and ageing states appear in martensitic structural-transition models, slowly re-equilibrating after temperature quenches, under Monte Carlo dynamics. Concepts from protein folding and ageing harmonic oscillators turn out to be useful in understanding these nonequilibrium evolutions. We show how the athermal, non-activated delay time for seeded parent-phase austenite to convert to product-phase martensite, arises from an identified entropy barrier in Fourier space. In an ageing state of low Monte Carlo acceptances, the strain structure factor makes constant-energy searches for rare pathways, to enter a Brillouin zone `golf hole' enclosing negative energy states, and to suddenly release entropically trapped stresses. In this context, a stress-dependent effective temperature can be defined, that re-equilibrates to the quenched bath temperature.Comment: 11 pages, 12 figures. Under process with Phys. Rev. B (2015

A Qualitative Study on the Feasibility and Benefits of Foot Hygiene Measures Practiced by Patients with Brugian Filariasis

Disability alleviation is an important component of Global Programme for Elimination of Lymphatic Filariasis'. In Brugia malayi infection the disability is largely due to acute attacks of adenolymphangitis (ADL), which frequently prevent patients from attending their normal activities, causing much suffering and economic loss. The foot care programme has been shown to reduce the frequency and severity of these episodes. In the present study we used semi-structured interviews to evaluate the impact of the foot care in 127 patients with brugian filariasis. They were previously trained in this procedure and were advised to practice it regularly, unsupervised. All except one could recollect the various components of foot hygiene and were practicing it regularly. They were aware of the factors causing ADL attacks and were able to avoid them. Majority (95.2%) expressed their happiness with the relief provided by foot care, which prevented or reduced the ADL episodes. The motivation was such that they transmitted this knowledge to others suffering in the community and even physically helped them to carry out foot care. This study fully endorses the advocacy of foot care programme as an easy to carry out, effective, sustainable and economically feasible ,procedure to prevent acute ADL attacks

Diagnostic utility of fecal calprotectin as a biomarker of gut inflammation in neonates to predict necrotizing enterocolitis: A prospective study

Background: Necrotizing enterocolitis (NEC) is a neonatal emergency that affects preterm newborns during the 1st weeks of life.Diagnosis is made mainly by clinical criteria since no specific diagnostic tests are available. Objective: The objective was to evaluatefecal calprotectin (fCal) as a biomarker of gut inflammation to predict NEC in preterm neonates. Methods: Design: Diagnostic testevaluation. Inclusion criteria: 102 preterm neonates &lt;36 weeks gestation and within 7 days of birth admitted in Level III neonatalintensive care unit (NICU) were recruited from January 2010 to May 2011. Exclusion criteria: Congenital anomalies and overt infection.Paired stool samples at day 3 and 7 were analyzed by lateral quantum blue rapid calprotectin assay. Cut-off values of fCal weredetermined among 30 term healthy infants. A structured questionnaire which included gestational age, symptoms at admission, andmodified Bell’s staging was used to record NEC episodes on day 3 and 7 of admission. Septic screen and radiological tools were doneas per NICU protocol. Results: 48% were above 34 weeks gestation; 31.3% were of very low birth weight. As per modified Bell’sstaging on day 3 and 7, 22 and 11 neonates had 1a or above stage, respectively. 15 had features of NEC; of these, 12 were managedappropriately and discharged and 3 died. In the receiver-operated curve with fCal &gt;279 μg/g as cutoff, the area under the curve was0.652 (95% confidence interval: 0.516-0.789). Day 3 fCal levels were high in 65.7% neonates. Using NEC as outcome, sensitivity of thetest was 93.3%; specificity was 39%; positive predictive value was 20.8% and negative predictive value was 97.14%. Conclusion: fCalhas high sensitivity for diagnosing NEC in preterm neonates. However, further research is needed to establish its clinical usefulness

Gamma-Ray Bursts: Temporal Scales and the Bulk Lorentz Factor

For a sample of Swift and Fermi GRBs, we show that the minimum variability timescale and the spectral lag of the prompt emission is related to the bulk Lorentz factor in a complex manner: For small $\Gamma$'s, the variability timescale exhibits a shallow (plateau) region. For large $\Gamma$'s, the variability timescale declines steeply as a function of $\Gamma$ ($\delta T\propto\Gamma^{-4.05\pm0.64}$). Evidence is also presented for an intriguing correlation between the peak times, t$_p$, of the afterglow emission and the prompt emission variability timescale.Comment: Accepted for publication in Ap