Emergency peripartum hysterectomy and its association with cesarean section: a 3 years retrospective study

Background: Emergency peripartum hysterectomy refers to the abdominal hysterectomy performed during or immediately after cesarean section or vaginal delivery, in a setting of life threatening haemorrhage. Over the past two decades, incidence of cesarean section has greatly increased which emerges as one of the cause for abnormal placentation in subsequent pregnancies thus resulting in increased incidence of haemorrhage. The unplanned nature of the surgery and acute blood loss renders the patient in a less than ideal situation to undergo such a dramatic surgery. Evaluation of risk factors, adequate resuscitation, involvement of senior obstetrician and timely decision for EPH in cases of refractory peripartum haemorrhage would help in significantly reducing the maternal mortality and morbidity. Objective was to study the association between cesarean section and emergency peripartum hysterectomy.  Methods: It is a retrospective study of all women who had undergone emergency peripartum hysterectomy between January 2015 to January 2018 in the Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College, Faridkot. Incidence, indications, risk factors and complications of emergency peripartum hysterectomies (EPH) were recorded.Results: During three years period the overall incidence of EPH was 1.85 per 1000 deliveries.Conclusions: Emergency peripartum hysterectomy is a challenging procedure performed in obstetrics when all other conservative methods to control uterine haemorrhage have failed. With increased incidence of cesarean sections the cause of emergency peripartum hysterectomy has greatly shifted from uterine atony to abnormal placentation.  Abnormal placentation has now become the most commonly associated indication for EPH. Recognising and assessing patients at risk with appropriate and timely intervention would help in ensuring a better outcome in this otherwise difficult situation

Improving higher education in India : the students' and government's perceptions

Mestrado em Políticas e Gestão do Ensino SuperiorO ensino superior na Índia tem desempenhado um papel importante no desenvolvimento económico e social do país. A educação é considerada como uma ferramenta fundamental na promoção da cultura e da igualdade entre os cidadãos. Embora sendo essencial para promover mais oportunidades para todos, o aumento do auto-financiamento por parte das instituições de ensino superior, em virtude das pressões governamentais, resultando, por vezes, em privatizações, tornou a educação inacessível para alguns. Actualmente apenas 7%da população entre os 18 e os 24 anos participam no ensino superior. Este estudo procura analisar as percepções do governo e dos estudantes relativamente às diferentes formas que podem ser utilizadas para melhorar o sistema de ensino superior. Um estudo foi desenvolvido baseado na análise de conteúdo de documentos oficiais do Ministério da Educação e do discurso dos estudantes recolhidos através de 17 entrevistas. A análise revela diferenças entre as percepções do governo e dos alunos às quais subjazem, igualmente, diferenças entre as concepções que ambos possuem relativamente aos papéis consignados ao ensino superior na sociedade. ABSTRACT: Higher education in India has played a significant role in the economic as well as social development. Education is considererd as an important tool to promote country’s culture and equality amongst the citizens. Although it seems essential to provide more opportunities to everyone, the growth of self-financing institutions encouraged by the government, resulting in privatisation, has made education out of reach. At present only 7 percent of youth in the age group of 18-24 participate in higher education. This study tries to analyse government and students’ perceptions about the different ways higher education in India can be improved. A qualitative study was developed based on content analysis of government documents and 17 students’ interviews. The analysis reveals differences between students and government perceptions that translate also different conceptions about higher education roles in society

Awareness about reproductive health, contraceptive methods, STDs including HIV/AIDS, and HPV vaccine, among adolescent girls in district Faridkot in Punjab

Background: Adolescents are more vulnerable than adults to unplanned pregnancies and sexually transmitted diseases including HIV/AIDS. Female adolescents have a higher risk of contracting an STD than their male counterparts. Hence creating awareness in them about reproductive health is the need of the hour.Methods: This was a cross sectional school based Study which was conducted in various schools of Faridkot city of Punjab where 400 Adolescent girls of class 11th and 12th age between 16-19 years, studying in English medium schools in district Faridkot through predesigned multiple choice questionnaires.Results: In our study, most of the girls (67%) were not aware about the meaning of reproductive health. Amongst contraceptive methods, 62.5% knew about condoms. The awareness about STDs was highest about HIV/AIDS (70.75%) and low (less than 20%) for other STDs. They also scored low about symptoms and route of transmission of STD’s. Only 17% of the girls knew about HPV vaccine. Attitude towards sex education was positive.Conclusions: Poor knowledge in girls about Reproductive Health and STDs (other than HIV/AIDS) is of serious concern. Therefore, education about reproductive health should be incorporated in the curriculum which should be given through teaching, interpersonal communication, television, health camps and specialist

Self administered medical abortion pills: evaluation of the clinical outcome and complications among women presenting with unsupervised pill intake to a tertiary care hospital in Malwa region of Punjab, India

Background: Unsupervised medical abortion pill intake is becoming a public health hazard. Because of its widespread misuse, we planned to undertake this study to evaluate the clinical presentation and outcome of such patients.Methods: Hundred patients meeting inclusion criteria were included. Clinical presentation, treatment given and, outcome and complications were analyzed.Results: Majority (53%) patients were aged between 30-39 years. Seventy-seven percent were gravida three or more. Only 26% had taken the pill within prescribed gestational age limit for MTP (<seven weeks). Mid-trimester pill intake was encountered in 13 % patients. Pill was consumed without any prior medical consultation by 73% patients. Majority (49%) presented with incomplete abortion requiring surgical evacuation. Anaemia was most common associated co-morbidity in 80% patients and 28% required blood transfusions. Twenty-four percent patients presented with life threatening shock. Sepsis was noted in 3% patients. Emergency laprotomy was required in 11% cases. Continuation of pregnancy was reported in 13% patients. Unintended pregnancy and failure of contraception were main reasons cited for abortion by 38% and 26% women. Non-contraceptive users constituted 48% patients . Over the counter easy availability was the main reason for unsupervised pill intake in 58% cases.Conclusions: Unauthorized over the counter pill availability despite legal ban and ignorance of women have led to increased number of unsafe abortions. Strict legislations need to be imposed. Increasing awareness among women regarding complications of unsupervised pill intake and easy availability of safe contraceptive methods can help control this problem

Successful maternal and fetal outcome of pregnancy following heart valve replacement using a sequential anti coagulation regime

Background: Patients with mechanical heart valves require anticoagulation which is associated with significant maternal mortality (1-4%) and fetal complications (31%) in pregnancy.  Methods: A prospective study was carried out enrolling  pregnant patients with mechanical heart valves who were booked at our institution for antenatal care, managed using a sequential  anticoagulant regime consisting of warfarin and low molecular weight heparin and delivered at our utility over two years.Results: We had seven cases of pregnancy following heart valve replacement over a period of two years with no fetal malformations and successful maternal outcome (71.43% term deliveries).Conclusions: LMWH until 13th week of gestation, followed by warfarin until late third trimester (36 weeks), then restarting LMWH until delivery in pregnant patients with mechanical heart valves was associated with successful maternal and fetal outcome.

Jansky Very Large Array detections of CO(1-0) emission in HI-absorption-selected galaxies at z≳2z \gtrsim 2

We report a Karl G. Jansky Very Large Array search for redshifted CO(1-0) emission from three HI-absorption-selected galaxies at $z \approx 2$, identified earlier in their CO(3-2) or CO(4-3) emission. We detect CO(1-0) emission from DLA B1228-113 at $z\approx2.1933$ and DLA J0918+1636 at $z\approx2.5848$; these are the first detections of CO(1-0) emission in high-$z$ HI-selected galaxies. We obtain high molecular gas masses, $\rm M_{mol}\approx10^{11}\times(\alpha_{\rm CO}/4.36)\ M_\odot$, for the two objects with CO(1-0) detections, which are a factor of $\approx1.5-2$ lower than earlier estimates. We determine the excitation of the mid$-J$ CO rotational levels relative to the $J=1$ level, r$_{ J1}$, in HI-selected galaxies for the first time, obtaining r$_{\rm 31}=1.00\pm0.20$ and r$_{\rm 41}=1.03\pm0.23$ for DLA J0918+1636, and r$_{\rm 31}=0.86\pm0.21$ for DLA B1228-113. These values are consistent with thermal excitation of the $J=3,4$ levels. The excitation of the $J=3$ level in the HI-selected galaxies is similar to that seen in massive main-sequence and sub-mm galaxies at $z\gtrsim2$, but higher than that in main-sequence galaxies at $z\approx1.5$; the higher excitation of the galaxies at $z\gtrsim2$ is likely to be due to their higher star-formation rate (SFR) surface density. We use Hubble Space Telescope Wide Field Camera 3 imaging to detect the rest-frame near-ultraviolet emission of DLA B1228-113, obtaining an NUV SFR of $4.44\pm0.47$ M$_{\odot}$ yr$^{-1}$, significantly lower than that obtained from the total infrared luminosity, indicating significant dust extinction in the $z\approx2.1933$ galaxy.Comment: 9 pages, 4 figures, and 2 tables. Accepted for publication in ApJ

A non-destructive approach for measuring rice panicle-level photosynthetic responses using 3D-image reconstruction

Our understanding of the physiological response of rice inflorescence (panicle) to environmental stresses is limited by the challenge of accurately determining panicle photosynthetic parameters and their impact on grain yield. This is primarily due to lack of a suitable gas exchange methodology for panicles, as well as non-destructive methods to accurately determine panicle surface area. To address these challenges, we have developed a custom panicle gas exchange cylinder compatible with the LiCor 6800 Infra-red Gas Analyzer. Accurate surface area measurements were determined with a 3D panicle imaging platform to normalize the panicle-level photosynthetic measurements. We observed differential responses in both panicle and flag leaf for two temperate Japonica rice genotypes (accessions, TEJ-1 and TEJ-2) exposed to heat stress during early grain filling. There was a notable divergence in relative photosynthetic contribution of flag leaf and panicles for the genotype tolerant to heat stress (TEJ-2) compared to the less tolerant accession. The novelty of this approach is that it is non-destructive and more accurately determines panicle area and photosynthetic parameters, enabling researchers to monitor temporal changes in panicle physiology during the reproductive development. The method is useful for panicle-level measurements under diverse environmental stresses, and for evaluating genotypic variation for panicle physiology and architecture in other cereals with compact inflorescences