Elective induction of labour at 39 weeks versus expectant management up to 41 weeks in a tertiary care centre

Background: The timing of delivery and effective management of labour at term makes a huge difference in the obstetric and perinatal outcome. There have always been controversies between choosing the elective induction of labour at 39 weeks versus expectant management up to 41/42 weeks which can result in placental ageing, reduced liquor, non-assuring fetal heart tracings, meconium stained amniotic fluid and fetal macrosomia.  our objective was to perform a comparative effectiveness analysis of elective induction of labor at 39 weeks gestational age among nulliparous women with uncomplicated singleton pregnancies as compared to expectant management up to 41 weeks.Methods: 120 primigravidae with singleton pregnancies with fetus in cephalic presentation were recruited into the study and divided into 2 groups of 60 each A: Patients were induced electively using dinoprostone gel (maximum 3 doses 8 hours apart) B: They were managed expectantly up to 41 weeks allowing for spontaneous onset of labour, induction or cesarean section was done for obstetric indications between 39 and 41 weeks and pregnancy was  terminated by induction for those who continued up to 41 weeks. Their obstetric and perinatal outcome were noted.Results: The cesarean section rates were higher in the expectantly managed group (21%) when compared to the electively induced group (16%). The same was with instrumental delivery rates (15% versus 10%). The perinatal outcome was poorer for the expectantly managed group with 20% NICU admissions and 5% perinatal deaths compared to the electively induced group which had 12% NICU admissions and 3.3% perinatal deaths. The expectantly managed group also resulted in respiratory distress in a larger number of fetuses and resulted in problems due to reduced liquor.Conclusions: Elective induction at 39 weeks gestational age was found to be a better option compared to expectant management up to 41 weeks in terms of obstetric and perinatal outcomes

Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy, and expulsion

Background: More than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. The study was conducted to assess the safety, incidence of perforation /pain/bleeding/foul discharge and expulsion rates at 6 week follow-up and willingness to continue when Cu T 380 A inserted within ten minutes of placental expulsion both in vaginal and C-section deliveries.Methods: This was an open label, prospective, and longitudinal study. The study was approved by the ethics committee of FOGSI.Results: The insertion of Intrauterine Contraceptive Devices (IUCD) at KIMS, Hubli was easy in 99.52% of subjects after normal delivery and 100% in all subjects after assisted vaginal deliveries. The position of the CuT was in situ in 94.78% of subjects, ultra sonogram was used in 24.76 % to confirm location where threads were not visible in the vagina and in 6.19% of subjects the tip of IUCD was in the cervix which was pushed back into the uterus using artery forceps. It was expelled in 5.23% of patients. There was no case of perforation in this series and no other major complications.Conclusions: Inserting CuT 380 A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus

Emergency internal iliac artery ligation: a conservative lifesaving procedure

Background: Internal iliac artery ligation (IIAL) is a surgical approach which causes a drop in arterial pressure and virtual elimination of the Trip-hammer effect and also preserves fertility. The objective was to study the role of IIAL in arresting and preventing postpartum hemorrhage (PPH).Methods: A retrospective case series involving examination of the files of all the women who had Internal iliac artery ligation between June 2013 and May 2015 in the department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli.Results: Out of the 15 women who underwent IIAL, 14(93.3%) had therapeutic IIAL and 1(6.67%) had prophylactic IIAL. Associated procedures like B-Lynch sutures, ovarian a. ligation and uterine a. ligation were performed before the decision for IIAL. Hysterectomy was performed in 5 cases to arrest hemorrhage (33.3%). Two woman died inspite of IIAL and subtotal hysterectomy due to uncontrolled PPH. No patient suffered pelvic organ injury or ischaemic complications.Conclusions: Bilateral ligation of Internal Iliac artery is a safe, rapid and effective way of treating PPH. Early resort to IIAL prevents hysterectomy in women with atonic PPH

Some Necessary Conditions and a General Sufficiency Condition for the Validity of A Gilmore-Gomory Type Patching Scheme for the Traveling

One of the most celebrated polynomially solvable cases of the TSP is the Gilmore-Gomory TSP. The patching scheme for the problem developed by Gilmore and Gomory has several interesting features. Its generalization, called the GG-scheme, has been studied by several researchers and polynomially testable sufficiency conditions for its validity have been given, leading to polynomial schemes for large subclasses of the TSP. A good characterization of the subclass of the TSP for which the GG-scheme produces an optimal solution, is an outstanding open problem of both theoretical and practical significance. We give some necessary conditions and a new, polynomially testable sufficiency condition for the validity of the GG-scheme that properly includes all previously known such conditions. Key words: Traveling salesman problem, Gilmore-Gomory TSP, Patching Scheme, Polynomially solvable case

Optimization of sliding specific wear and Frictional force behaviour of Modified ZA-27 alloy using Taguchi Method

Dry sliding wear behavior of Modified ZA-27 alloy was prepared by gravity die casting. The specific wear rate and frictional force of Modified ZA-27 alloy was studied by performing wear test using a pin-on-disc wear tester. Experiments were conducted according to plan of experiments generated using taguchi method. A L25 orthogonal array was used for analysis of data. ANOVA is used to study the influence of process parameters such as Normal load and sliding speed on specific wear rate and frictional force. Regression analyses are employed to find the optimal process parameter levels and to analyze the effect of these parameters on Modified ZA-27 alloy. The result reveals that Normal load and sliding speed were the more sensitive parameters. DOI: 10.17762/ijritcc2321-8169.15053

Analysis of Wear Behaviour of a Heat Treated Modified ZA-27 Alloy by Taguchi Technique

The aim of this paper is to examine the dry sliding wear beahviour of as-received and heat treated Modified ZA-27 alloy. The alloys were prepared by conventional melting and casting route technique. The as-received samples were annealed at 3700C for 5 hours, followed by water quenching and also furnace cooling. The experiments were conducted according to plan of experiments generated through taguchi technique. A L25 Orthogonal array was selected for analysis of the data along with the analysis of variance (ANOVA) were employed to investigate the influence of process parameters on the wear behaviour of as-received and heat treated Modified ZA-27 alloy. Regression models were used to investigate the influence of process parameter on wear rate. The result reveals that Normal Pressure is the more sensitive parameter

ESTABLISHING A PLATFORM FOR SPRAY DRYING INHALABLE VACCINES IN SOUTH AFRICA

Mycobacterium bovis BCG is the current vaccine for tuberculosis (TB). However, BCG as it is currently administered shows highly variable efficacy in protecting adults against TB. The natural route of infection of TB is via inhalation of bacilli-containing aerosols and it is postulated that immunization by the natural route of infection may lead to a greater immunity given the fact that the lungs are the primary target of infection. By eliciting both local and systemic immune responses, it is anticipated that an inhaled form of BCG will offer greater protection against pulmonary TB. Current commercial BCG vaccine preparations are filled as bacterial suspensions in vials, dried through lyophilization and stabilized through refrigeration with a one year shelf life. However, freeze-dried BCG does not exhibit a particle form conducive for delivery via the aerosol route and must be injected. Spray drying studies by Harvard University and Medicine in Need (MEND) scientists have demonstrated that BCG could be spray dried into a viable aerosol with up to 1 year of stability under refrigerated conditions, with the potential for room temperature stability. To support the further preclinical development of the BCG aerosol for application in the developing world, MEND established a state-of-the-art Biosafety level 3 spray drying facility with local expertise in South Africa, where the vaccine will be produced for an IND-enabling toxicology study meeting OECD Good Laboratory Practice (GLP) requirements. Frozen BCG bulk is spray dried and the resulting dry powder is characterized in terms of viability and aerosol properties. The dried BCG aerosol is then aseptically filled into capsules using a semi-automatic filling device for delivery using a low-cost hand-held inhaler. In conclusion, the spray drying technology was successfully transferred from Harvard University to the MEND facility in Pretoria. MEND is developing local expertise and infrastructure to support further preclinical and clinical development of BCG for inhalation

Proteomics: in pursuit of effective traumatic brain injury therapeutics

Effective traumatic brain injury (TBI) therapeutics remain stubbornly elusive. Efforts in the field have been challenged by the heterogeneity of clinical TBI, with greater complexity among underlying molecular phenotypes than initially conceived. Future research must confront the multitude of factors comprising this heterogeneity, representing a big data challenge befitting the coming informatics age. Proteomics is poised to serve a central role in prescriptive therapeutic development, as it offers an efficient endpoint within which to assess post-TBI biochemistry. We examine rationale for multifactor TBI proteomic studies and the particular importance of temporal profiling in defining biochemical sequences and guiding therapeutic development. Lastly, we offer perspective on repurposing biofluid proteomics to develop theragnostic assays with which to prescribe, monitor and assess pharmaceutics for improved translation and outcome for TBI patients