Cancer treatment-related distress: evaluating the effectiveness of psychosocial interventions

This thesis is presented in two volumes. Volume I is the research component consisting of a literature review and empirical paper each concerned with the effectiveness of psychosocial interventions on cancer treatment-related distress and symptoms. Volume II is the written clinical component, comprising five Clinical Practice Reports. Volume I The literature review is a systematic evaluation and critique of empirical research published since 1990 to evaluate the effectiveness of psychosocial interventions on distress, symptoms and quality of life specifically in relation to cancer treatment. Thirty-one relevant studies were identified evaluating 38 different interventions. The review included an assessment of the quality of the interventions and study designs of included studies. Interventions were grouped into relaxation, cognitive-behavioural, hypnosis and supportive interventions. … The empirical paper presents a pilot study designed to evaluate the effectiveness of a psychological preparation session on women’s distress prior to and following invasive internal radiotherapy treatment for gynaecological cancers. This brief intervention was found to prevent further deterioration in anxiety and depression prior to treatment. Significantly more patients in the control group were found to experience greater anxiety and depression prior to treatment compared to the intervention group. The limitations of this empirical study, suggestions for future research and clinical implications are also discussed

Understanding the Recognition of Mixed Sequence DNA through Minor Groove Binding Compounds

The broad range of diseases controlled by transcription factors (TFs) and their potential abilities to modulate gene expression have led to an emerging interest in the development of small molecules that target TF-DNA complexes. Still, there is only a limited number of types of designed small molecules that show strong and sequence-specific binding to DNA along with good cellular uptake properties for therapeutic use. Most of the successful nuclear stains or therapeutic agents that bind non-covalently in the minor groove of DNA are AT specific. Synthesis of novel compounds to better target the mixed AT/GC base pair (bp) sequences with a broad range of applications like targeting TF is a daunting task. Our novel heterocyclic cation, DB2277, contains the aza-benzimidazole group (aza-BI) that specifically recognizes the single GC bp interspersed between AT bp sequences in the minor groove of DNA. NMR spectroscopy revealed the presence of major and minor binding species in the DB2277 complex with AAAGTTT type of DNA. NMR exchange dynamics have shown that the exchange between major and minor species is much faster than the compound’s dissociation from the complex, as determined using surface plasmon resonance (SPR). To understand the molecular basis of recognition of mixed bp sequences and to acquire ideas to design new sequence-specific compounds, structural information of the DB2277-DNA complex is essential. Experimental structure of the unique and selective binding orientation of DB2277 with “AAGATA” binding site of DNA has been obtained using high-resolution NMR and molecular dynamics (MD) simulations, which suggests the involvement of two specific and strong H-bonds in recognition of the central GC bp. Extended MD calculations have shown dynamic water-mediated H-bond contacts between amidine of DB2277 and the bases at the floor of the minor groove and 180° rotations of the phenyl linked to a flexible linker (OCH2) in a bound compound for the first time. Therefore, designing additional compounds with the ability to recognize a vast array of biologically important DNA sequences is essential for extending the use of new heterocyclic compounds in therapeutic applications in the future

Perinatal Outcome of Deliveries after One Previous Caesarean Section

Introduction: Contrary to the WHO recommended caesarean section (CS) rate of 15%, there is an alarming trend of increasing caesarean section rates. An important reason for this is repeat caesarean section (RCS). Vaginal birth after caesarean (VBAC) is one of the methods of reducing CS rates in women with history of previous CS. This study was done with the aim to see the maternal and fetal outcome among parturient with history of single previous caesarean section and to determine the rate of VBAC at Lumbini Medical College, Nepal. Methods: This is a prospective study done for a period of ten months. Seventy parturient fulfilling inclusion criteria of term pregnancy with single live fetus and history of one Lower Segment Caesarean Section (LSCS) were enrolled in the study. Patients meeting the criteria for VBAC were given trial of labour and others were taken for elective repeat CS. This cohort was analyzed further, with respect to age, parity, period of gestation, mode of delivery, indication for CS, maternal and fetal complications and outcomes. Results: VBAC was successful in 27.14% of patients (n=19) while the rest 51 (72.85%) underwent RCS . Indications for RCS was mainly scar tenderness 7 (13.7%), fetal distress 6 (11.7%), non progress of labour 6 (11.7%), meconium stained liquor 6 (11.7%) and post-dated pregnancy 6 (11.7%). Maternal morbidity was comparable in women undergoing RCS or VBAC. There was one still birth and one early neonatal death in each group due to complications of meconium aspiration. Conclusion: Patients with previous CS are at high risk of RCS. If trial of labor is allowed under careful patient selection and supervision, the rate of vaginal delivery after caesarean section can be increased safely. As there is no added perinatal morbidity and mortality in cases of VBAC as compared to RCS, VBAC shows the right way forward to decrease the rate of caesarean section

Effect of non-homogeneity on free vibration of visco-elastic rectangular plate with varying structural parameters

Free vibration of a non-homogeneous rectangular plate with thickness varying as an exponential function of abscissa in the plane of the plate is discussed. The non-homogeneity of the plate’s material is characterized by assuming an exponential variation in poisson’s ratio of the plate’s material. Also, temperature variation is considered exponentially in one direction. Plate is assumed to be clamped at all the edges and visco-elastic properties of material are taken as ‘Kelvin’ type. The first two modes of frequency are reported here for various combinations of structural parameters i.e. non-homogeneity constant, thermal gradient, taper constant and aspect ratio of the plate. The results are calculated for a visco-elastic alloy of Aluminum i. e. Duralium. Results of the present paper are compared with known results and are found in excellent agreement

Pattern of Severe Acute Maternal Morbidity in a Tertiary Care Institute

Introduction: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases of severe acute maternal morbidity (SAMM), also termed as 'near miss obstetrics events', has been found to be a useful supplementary indicator to investigate maternal health care. Cases of near miss are those in which women present with potentially fatal complication during pregnancy, delivery, or the puerperium and survive merely by chance or by good hospital care. This study was done with the objective to analyze cases of SAMM at Lumbini Medical College Teaching Hospital (LMCTH), Nepal. Research Methods: A retrospective study of all cases meeting the WHO criteria for SAMM,  during May 2015, was done. Cases meeting the WHO eligibility criteria for near miss cases were included in the study. Medical record of such cases in past one year was reviewed. Their socio-demographic variables, parity, gestational age, associated organ dysfunction, ICU and hospital stay, management, and fetal and maternal outcome were noted. Results: During the study period, there were total of 28 cases of SAMM and two maternal mortality out of 2735 live births. Thus rate of SAMM was 1.02%, and maternal mortality rate was 0.07%. Majority of patients were unbooked (n=18, 64.28%) and 10 (35.71%) were illiterate. Commonest causes for admission to ICU was hemorrhage (n=10, 35.71%) followed by hypertensive disorders (n=9, 32.06%), sepsis (n=2, 7.14%), and obstructed labour (n=2, 7.14%). Laparotomy was performed in six (21.42%) women, obstetric hysterectomy in four (14.28%), and pelvic devascularization in two (10.71%). Conclusion: SAMM is a useful adjunct to maternal mortality to assess maternal health care. Improving facility based care and prompt referral, education of primary health care (PHC) staff can be a short term measure to quickly reduce the number of maternal deaths. Facility based monitoring and reporting of SAMM outcome is an important step for scaling up such efforts

Antimycotic activity of biogenically synthesised metal and metal oxide nanoparticles against plant pathogenic fungus Fusarium moniliforme (F. fujikuroi)

263-270Consistent and injudicious application of antifungal agents to control fungal pathogens on crops results in off-target ill-effects on livestock and human health besides issues, such as disruption of ecological balance. In this context, development of novel specific antifungal agents such as metal or metal oxide nanoparticles without side effects becomes a necessity. Here, we attempted green synthesis of three different metal and metal oxide nanoparticles (NPs) (Ag, ZnO and FeO) by incubating metal salts with Trichoderma harzianum hyphal or mycelial extract (HE). The AgNPs were also generated using hyphal filtrate (HF). The synthesized nanoparticles were characterized by microscopy and spectroscopy techniques and evaluated by poisoned food technique/agar well diffusion technique under in vitro conditions on Czapek dox agar against plant pathogenic fungus Fusarium moniliforme. The tested NPs exhibited varied efficacy for curbing the growth of F. moniliforme. A NP concentration dependent increase in percent growth inhibition was recorded for the above mentioned three types of NPs. Moreover, the antimycotic efficacy of the microbial synthesized Ag NPs also varied for the T. harzianum cell free filtrate and hyphal extract formulations. Maximum percent hyphal growth inhibition (58.83%) was recorded for T. harzianum HE Ag NPs at 800 ppm followed by FeO NPs at 400 ppm (40.38%)

Influence of Drought and Sowing Time on Protein Composition, Antinutrients, and Mineral Contents of Wheat

The present study in a two-year experiment investigated the influence of drought and sowing time on protein composition, antinutrients, and mineral contents of wheat whole meal of two genotypes differing in their water requirements. Different thermal conditions prevailing during the grain filling period under different sowing time generated a large effect on the amount of total soluble proteins. Late sown conditions offered higher protein content accompanied by increased albumin-globulin but decreased glutenin content. Fe content was increased to 20–23%; however, tannin decreased to 18–35% under early sown rain-fed conditions as compared to irrigated timely sown conditions in both the genotypes. Activity of trypsin inhibitor was decreased under rain-fed conditions in both genotypes. This study inferred that variable sowing times and irrigation practices can be used for inducing variation in different wheat whole meal quality characteristics. Lower temperature prevailing under early sown rain-fed conditions; resulted in higher protein content. Higher Fe and lower tannin contents were reported under early sown rain-fed conditions however, late sown conditions offered an increase in phytic acid accompanied by decreased micronutrients and glutenin contents