Understanding Fast and Slow Variables as a Means to Effectively Manage Implications of Rapid Change in Karimunjawa National Park, Indonesia

This research examined social-ecological regime shifts (SERS), in Karimunjawa National Park, in Indonesia, which is home to primarily small-scale fishers. This study largely followed a conceptual understanding of critical slow variables that are often formed over multiple years within a complex social-ecological system. Such slow forming variables including wealth and infrastructure, and fish biomass and biodiversity are important because they determine system functions and interact with fast variables such as local income and fishing efforts to form feedback interactions. Frequent system changes amongst fast variables can cause unpredictable and irreversible change in slow variables, that usually take years and decades to manifest. Local coastal communities are often forced to adapt to ecological changes when the continuity of their natural resource dependent livelihoods, that are extractive and exploitive, is deemed unsustainable. This research used a qualitative and inductive approach, to understand interactions among fast and slow variables to determine any indications of a social-ecological regime shift. Data collection methods included semi-structured interviews with key informants (n=60), surveys (n=27), and focus groups. The main objectives that guided this research are: 1) examining fast and slow changing variables within the social and ecological subsystems of Karimunjawa National Park in order to understand the phenomenon of rapid change; 2) identifying local responses to social-ecological change in order to assess local adaptive capacity; and 3) determining governance implications associated with the interactions and outcomes of fast and critical slow variables in Karimunjawa National Park. The results indicated that understanding feedback interactions amongst fast and slow variables can provide insights on dual directionality of drivers of change with implications on targeted management of critical slow variables. In a social-ecological system, local autonomy and empowerment with appropriate monitoring efforts can be found to enhance the management of slow forming variables and foster resilience

Hysterectomy for dysfunctional uterine bleeding in the era of uterine conservation

Background: Hysterectomy is one of the modalities to manage dysfunctional uterine bleeding (DUB) where medical management fails or is contraindicated. Hysterectomy leads to guaranteed cure but does have a significant morbidity rate. In this era of popularization of various uterine conservation techniques there is a definite need to audit justification of causes which led to hysterectomy in DUB.Methods: Women with a diagnosis of DUB, based on clinical and ultrasound findings, which underwent endometrial sampling/curettage were recruited for the study. All these patients were followed up. Those who underwent hysterectomy for the sake of DUB were thoroughly studied. Information regarding the histopathology report of hysterectomy specimen was collected. Finally reason and justification of hysterectomy for these women was evaluated.Results: A total of 252 women were with DUB were included. In this group 76 women (30.2%) underwent hysterectomy. Noncompliance to medical management was the most common indication (in 37.6% women), which led to hysterectomy in our study group. Significant result was seen with final histology of simple endometrial hyperplasia in which 19 out of 41 (46.4 %) cases were missed on curettage. Similarly around 50% cases (21 out of 43) diagnosed as simple hyperplasia on curettage had normal endometrium on final histopathology. Contrary to this a 100% concordance was seen in complex hyperplasia (without atypia), with only two cases in our sample. More than three fourth (78%) cases had a coincidental pathology in the myometrium.Conclusions: Thorough counseling for the benefits and side effects of medical management prior to starting it is imperative, as the most common indication for hysterectomy for DUB was non-compliance to medical management.  If women with normal histopathology reports on curettage are not responding to medical management, further imaging and sampling is required. Women non responsive to medical management may have underlying/ co-existent myometrial pathology.

Prediction of adverse effects of preeclampsia

Background: To predict the adverse maternal, perinatal and combined (both maternal and perinatal) outcome in preeclampsia by using various clinical and laboratory variables. Methods: Five hundred fifty women diagnosed with preeclampsia were included and twenty-four women were excluded from the study due to exclusion criteria, six women decline to participate, twenty women were lost to follow up, three women withdrew consent, so a total of 497 women were followed up in the study.Results: Mean age of study population was 26.82±4.48 years. Majority of women with preeclampsia delivered vaginally. Forty-five (9.05%) developed neurological complication. Mean gestational age at delivery (weeks) in patients who developed adverse outcome was 34.58±3.74 weeks and in patients with normal outcome is 38.62±1.59 weeks. Mean birth weight of newborns were 2.1±0.73 kg and 1.85±0.61 kg for newborns with adverse outcomes. Majority of perinatal complication was small for gestational age 267 (54.37%) followed by prematurity 262 (53.36%). Total number of adverse perinatal events was six hundred seventy-seven as multiple neonates had more than one perinatal outcome. In combined (both maternal and perinatal) adverse outcome-374 (75%) developed adverse outcome, 123 (25%) developed normal pregnancy outcome.Conclusion: This study found out simple clinical, biochemical tools for monitoring pregnant women and accurately identifying who was at greatest risk of severe complications. By identifying those women at highest risk of adverse maternal outcomes well before that outcome occurs, transportation and treatment can be targeted to those women most in need. This clinical prediction tool found to be an important contributor as it offers the potential to improve health outcomes of women for a condition that is at the root of a large amount of morbidity and mortality in the developing world

LAVH or TAH – choosing it wise and making it safe

Background: Hysterectomy is the most commonly performed surgery in our gynaecological practice, abdominal route being the most common. Here we compare the various features and outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH).Methods: The study design is a retrospective observational study. Outcome measures were indication, duration, complications of surgery, post op recovery and cost following TAH and LAVH.Results: A total of 116 cases underwent hysterectomy. Of these 98 underwent TAH and 18 underwent LAVH. Commonest indication for TAH in our study was fibroid followed by abnormal uterine bleeding (AUB); whereas in LAVH it was AUB followed by fibroid. Mean operating time in TAH was 118 minutes whereas in LAVH it was 166 minutes. One patient who underwent LAVH had ureteric injury and another had vault abscess. There were no major complications among TAH cases. A few patients had minor complications like fever, wound infection and urinary tract infection following TAH whereas fever was the only minor complication seen in a minority of the LAVH patients. Mean fall in haemoglobin in TAH was 1.05 gm% whereas in LAVH it was 0.95 gm%. None of the patients required postoperative blood transfusion. A few patients following TAH required additional analgesics apart from routine whereas in LAVH none required it. Mean duration of hospital stay following TAH was 6.84 days where as in LAVH it was 3.1 days. Mean hospital expenses in TAH were INR 28480, while for LAVH it was 44360.Conclusions: Undoubtedly expertise is the decisive factor behind the success of hysterectomy. LAVH though advantageous in many aspects like less post operative pain and cosmetic benefits, it could be technically demanding with availability only in well-equipped centres and cost factors. Surgeons need to be trained in all modalities of hysterectomy

To study the association of Doppler derived indices of uterine artery resistance with composite of PIH/PET

Background: Hypertensive disorders of pregnancy (HDP) are among the main public health issues worldwide. They account for an estimated 10-15% of maternal deaths globally. Among the hypertensive disorders of pregnancy, pre-eclampsia is most dangerous, occurring in 10% of first pregnancies, and in 20-25% of women with past history of hypertension. The objective of present study is to investigate the association of Doppler derived Indices of uterine artery resistance with composite of PIH/PET.Methods: A prospective follow up observational study, including pregnant women at 11-13+6 weeks of gestation in whom Uterine Artery Resistance measured using Doppler ultrasound.Results: A total of 100 subjects were enrolled, out of which 11 developed pre-eclampsia/ gestational hypertension. All Doppler indices (Resistance Index, Pulsatility Index and Systolic/Diastolic Index) had high specificities and negative predictive values.Conclusions: The potential advantages of early screening of hypertensive disorders and their associated complications may allow investigations or prophylactic interventions before 20 weeks of gestation

Banking Umbilical Cord Blood (UCB) Stem Cells: Awareness, Attitude and Expectations of Potential Donors from One of the Largest Potential Repository (India)

<div><p>Background</p><p>The concept of Umbilical Cord blood (UCB) stem cells is emerging as a non-invasive, efficacious alternative source of hematopoietic stem cells to treat a variety of blood and bone marrow diseases, blood cancers, metabolic disorders and immune deficiencies. Aim of the present study was to determine the level of awareness about banking UCB among pregnant women in India. We also assessed patient perception for banking of UCB and explored the patient expectations of banking UCB in future. This is the first study to assess current attitudes, in a sample population of potential donors from one of the largest potential UCB repository (India). Obtaining this information may help optimize recruitment efforts and improve patient education.</p><p>Material and Method</p><p>Present explorative questionnaire based survey included 254 pregnant women in the final analysis.</p><p>Results</p><p>We established only 26.5% pregnant women in our study population knew what exactly is meant by UCB. A large proportion (55.1%) was undecided on whether they want to bank UCB or not. Women were more aware of the more advertised private cord blood banking compared to public banking. More than half of the pregnant women expected their obstetrician to inform them regarding UCB. One-third of the women in our population had undue expectations from banking of the UCB.</p><p>Conclusion</p><p>Obstetricians should play a more active role in explaining the patients regarding pros and cons of UCB banking.</p></div

Willingness to bank cord blood for research (if given an option), keeping in mind the larger picture of future benefit to the society.

<p>Willingness to bank cord blood for research (if given an option), keeping in mind the larger picture of future benefit to the society.</p

Demographic characteristics of the population studied.

<p>Demographic characteristics of the population studied.</p