Drotaverine to improve progression of labour among parturient women- a case control study

Background: Prolonged labour contributes to increased perinatal and maternal morbidity. Pharmacological interventions can hasten cervical dilation and help obstetrician to accomplish the delivery in the shortest possible time without compromising maternal and fetal safety. Aims and objectives were to evaluate the acceleration effect of drotaverine on the dilatation of the cervix in both primigravidae and multigravida and compare it with control group. Methods: A total of 70 patients were studied (35 in drotaverine group and 35 in control group). The inclusion criteria were pregnancy with at least 37 weeks completed, cervical dilatation 3-4 cm, regular uterine contractions and cephalic presentation. The study group received 40 mg drotaverine hydrochloride i.m. in active phase of labour, control group received standard delivery care. Parameters such as duration of first and second stage of labour, mode of delivery, neonatal outcome and side effects to drug was recorded. Results: 6 subjects from the study group and 4 from the control group developed complications in first stage of labour and were taken up for operative delivery and hence they were excluded from calculation of various labour parameters. The mean rate of cervical dilatation with drotaverine was 2.26 cm/hour, while it was 1.67 cm/hour without any intervention (p value <0.05). Mean duration of active phase of first stage of labor was 3.09 hours in drotaverine group against 4.98 hours in study group (p value <0.05). There were no significant untoward effects noted in either of the groups. Conclusions: Drotaverine was found to be an effective and safe drug in shortening the duration of the first stage of labor without any significant detrimental effects on the mother and newborn. Drotaverine did not interfere with uterine contractility and there was no increased incidence of operative deliveries.

Mullerian anomalies: a cause of primary amenorrhea

Background: The objectives of this study were to determine the etiologic causes of amenorrhea, the prevalence of müllerian anomalies as a cause of primary amenorrhea and the different varieties of müllerian anomalies causing primary amenorrhea.Methods: This study included all the women presenting with primary amenorrhea who presented to the department of obstetrics and gynecology, Sir T Hospital and Government Medical College, Bhavnagar from 1st January 2010 to 30th June 2012.Results: The causes of primary amenorrhea of our study due to obstructive anomalies were 37.72(n=5) and müllerian agenesis were 57.14% (n=8) and androgen insensitivity 7.14 (n=1).Conclusions: Mullerian agenesis is the most prevalent cause of primary amenorrhea in our study

Crystallographic characterisation of ultra-thin, or amorphous transparent conducting oxides:the case for raman spectroscopy.

The electronic and optical properties of transparent conducting oxides (TCOs) are closely linked to their crystallographic structure on a macroscopic (grain sizes) and microscopic (bond structure) level. With the increasing drive towards using reduced film thicknesses in devices and growing interest in amorphous TCOs such as n-type InGaZnO 4 (IGZO), ZnSnO 3 (ZTO), p-type Cu x CrO 2 , or ZnRh 2 O 4 , the task of gaining in-depth knowledge on their crystal structure by conventional X-ray diffraction-based measurements are becoming increasingly difficult. We demonstrate the use of a focal shift based background subtraction technique for Raman spectroscopy specifically developed for the case of transparent thin films on amorphous substrates. Using this technique we demonstrate, for a variety of TCOs CuO, a-ZTO, ZnO:Al), how changes in local vibrational modes reflect changes in the composition of the TCO and consequently their electronic properties

Release of ATP by pre-Bötzinger complex astrocytes contributes to the hypoxic ventilatory response via a Ca(2+) -dependent P2Y1 receptor mechanism

KEY POINTS: The ventilatory response to reduced oxygen (hypoxia) is biphasic, comprising an initial increase in ventilation followed by a secondary depression. Our findings indicate that, during hypoxia, astrocytes in the pre-Bötzinger complex (preBötC), a critical site of inspiratory rhythm generation, release a gliotransmitter that acts via P2Y1 receptors to stimulate ventilation and reduce the secondary depression. In vitro analyses reveal that ATP excitation of the preBötC involves P2Y1 receptor-mediated release of Ca(2+) from intracellular stores. By identifying a role for gliotransmission and the sites, P2 receptor subtype, and signalling mechanisms via which ATP modulates breathing during hypoxia, these data advance our understanding of the mechanisms underlying the hypoxic ventilatory response and highlight the significance of purinergic signalling and gliotransmission in homeostatic control. Clinically, these findings are relevant to conditions in which hypoxia and respiratory depression are implicated, including apnoea of prematurity, sleep disordered breathing and congestive heart failure. ABSTRACT: The hypoxic ventilatory response (HVR) is biphasic, consisting of a phase I increase in ventilation followed by a secondary depression (to a steady-state phase II) that can be life-threatening in premature infants who suffer from frequent apnoeas and respiratory depression. ATP released in the ventrolateral medulla oblongata during hypoxia attenuates the secondary depression. We explored a working hypothesis that vesicular release of ATP by astrocytes in the pre-Bötzinger Complex (preBötC) inspiratory rhythm-generating network acts via P2Y1 receptors to mediate this effect. Blockade of vesicular exocytosis in preBötC astrocytes bilaterally (using an adenoviral vector to specifically express tetanus toxin light chain in astrocytes) reduced the HVR in anaesthetized rats, indicating that exocytotic release of a gliotransmitter within the preBötC contributes to the hypoxia-induced increases in ventilation. Unilateral blockade of P2Y1 receptors in the preBötC via local antagonist injection enhanced the secondary respiratory depression, suggesting that a significant component of the phase II increase in ventilation is mediated by ATP acting at P2Y1 receptors. In vitro responses of the preBötC inspiratory network, preBötC inspiratory neurons and cultured preBötC glia to purinergic agents demonstrated that the P2Y1 receptor-mediated increase in fictive inspiratory frequency involves Ca(2+) recruitment from intracellular stores leading to increases in intracellular Ca(2+) ([Ca(2+) ]i ) in inspiratory neurons and glia. These data suggest that ATP is released by preBötC astrocytes during hypoxia and acts via P2Y1 receptors on inspiratory neurons (and/or glia) to evoke Ca(2+) release from intracellular stores and an increase in ventilation that counteracts the hypoxic respiratory depression

Principal Findings of the Invasive Blood Pressure Meta-Analysis Consortium (Inspect) on the Accuracy of Brachial Cuff Blood Pressure Devices

OBJECTIVE: Accurate measurement of blood pressure (BP) is crucial for hypertension management. Accuracy of brachial cuff (B_CUFF) devices to measure invasive (intra-arterial) BP at the brachial artery (B_INV) and aorta (A_INV) has never been systematically assessed. This study aimed to determine the: 1) relationship between B_INV and A_INV; 2) accuracy of B_CUFF devices to estimate invasive BP and; 3) accuracy of B_CUFF devices to classify BP thresholds. DESIGN AND METHOD: Three individual patient meta-analyses (by search of online databases and systematic review supplemented by measurements in a tertiary hospital cardiac catheterization laboratory) were performed to determine: 1) B_INV versus A_INV BP; 2) B_CUFF versus B_INV BP and A_INV BP and; 3) B_CUFF for BP classification versus invasive BP. RESULTS: Most subjects (90%) were patients undergoing cardiac catheterization (total N = 3004; mean age 58.7 years, 95%CI [54.0, 63.4], 68% male). As shown in the table: 1) B_INV systolic BP (SBP) was significantly higher than A_INV SBP whilst A_INV diastolic BP (DBP) was slightly higher than B_INV DBP. 2) B_CUFF underestimated B_INV SBP and overestimated B_INV DBP. The mean difference between B_CUFF SBP and A_INV SBP was small, whilst B_CUFF DBP overestimated A_INV DBP. However, according to mean absolute difference, B_CUFF and A_INV showed poor agreement. 3) B_CUFF correctly classified 31.1/28.4% of high-normal (SBP 130–139 mmHg), 54.2/52.6% of grade I (SBP 140–159 mmHg) and 45.2/50.3% of grade II (SBP 160–179 mmHg) hypertension cases, using B_INV/A_INV, respectively, as the reference. Correct classification was more frequent for SBP B_CUFF values 75%). CONCLUSIONS: While recognising the clinical importance of B_CUFF devices, there is wide variability in device accuracy for measuring intra-arterial BP. Although B_CUFF devices are reasonable for correctly classifying BP at low and very high BP thresholds, more accurate B_CUFF devices in the high-normal BP to grade II hypertension range should improve hypertension management

Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

Introduction Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United State