Correlation of non stress test with fetal outcome in term pregnancy (37-42 Weeks)

Background: The main purpose of the various antepartum surveillance techniques is to detect fetal distress so as to prevent fetal death. Traditionally, obstetricians tended to classify pregnant women as “low” and “high” risk. Although many well-organized methods are available for managing the high-risk group, we need more ef­ficient methods for identifying pregnant women in distress in the low-risk group. The idea of taking this study using NST as a tool for routine antepartum fetal surveillance is we will be trying to catch up those fetuses who might be at risk in womb and provide prompt intervention in otherwise considered normal pregnancies without any obvious high risk factor thus giving the best outcome in mothers. The objective of this study was to evaluate the correlation of the Non Stress Test with fetal outcome in pregnancies from 37-42 weeks of gestation.Methods: This was a prospective longitudinal study at Acharya Vinoba Bhave Rural Hospital Sawangi (Meghe) Wardha and Dept. of Obstetrics and Gynaecology Unit from August 2011- July 2013. This study included 100 normal pregnant mothers from 37 weeks to 42 weeks who were subjected to NST for 20 minutes.Results: The incidence of reactive test was 85% and that of Non reactive NST was 15% .As the gestational age advances the incidence of NR NST is more. Postdatism (gestation >40 weeks) is found to be an important factor for NR NST. Mode of delivery was related to results of Non stress Test in terms of maximum vaginal delivery in Reactive groups, Operative deliveries which occurred in the Reactive groups were also due to indications other than fetal distress. Caesarean section rate is slightly higher in non reactive NST. The individual parameters of poor fetal outcome like meconium stained liquor, Apgar score <7 at 5 minutes had increased incidences in the non reactive group.Conclusion: Routine electronic monitoring is accepted in high risk women, but normal pregnancies too require some reliable objective assessment to optimize the outcome. This study suggests that the NST was found to be a good predictor of the healthy foetus even in normal pregnancies between 37-42 weeks of gestation and the probability of an adverse outcome such as meconium-staining of liquor and poor Apgar score increases with a non reactive strip. However large randomized controlled trials are necessary to assess normal pregnancies to incorporate NST to monitor normal pregnancies

First report of Molecular Epidemiology of Carbapenem Resistant Enterobacteriaceae from a Tertiary Level Hospital in Rajasthan, Western India

Background: Carbapenem Resistant Enterobacteriaceae (CRE) are emerging at an alarming rate and pose a significant global threat. Objective: To conduct phenotypic and genotypic characterization of CRE strains from Rajasthan, Western India. Methodology: This was a prospective observational study conducted in Department of Microbiology, Dr S.N. Medical College, Jodhpur, Rajasthan from October to December 2018. All clinical samples received during the study period were processed and bacterial identification and antimicrobial susceptibility tests were performed according to standard microbiological guidelines. A total of 14 non duplicate carbapenem resistant clinical isolates of E coli and K pneumoniae were included in the study and subjected to Rapidec Carba NP test. Carbapenemase‑ encoding genes were amplified by multiplex polymerase chain reaction (PCR). PCR amplified products from three random isolates were subjected to Sanger sequencing. Results: Amikacin remained active against 36% isolates. All isolates were found to be susceptible to colistin and tigecycline. Carbapenemase production by Rapidec Carba NP test was noted in all (14/14) study isolates. All isolates were found to harbour ≥ 1 carbapenemase gene. The most common resistance gene observed was blaoxa (86%) followed by blaNDM (79%). None of the CRE isolates included in our study showed production of KPC enzymes. The sequences were analysed using BLAST analysis and were confirmed to be matching to OXA-48/181 and NDM-1. Conclusions: Growing carbapenem resistance is an important issue which needs urgent attention and blaOXA is an emerging mechanism of resistance among clinical CRE isolates in our setting Keywords: Carbapenem resistant Enterobacteriaceae, Phenotypic tests, Carbapenemase gene, Polymerase chain reactio

Loss of VHL in mesenchymal progenitors of the limb bud alters multiple steps of endochondral bone development

Adaptation to low oxygen tension (hypoxia) is a critical event during development. The transcription factors Hypoxia Inducible Factor-1α (HIF-1α) and HIF-2α are essential mediators of the homeostatic responses that allow hypoxic cells to survive and differentiate. Von Hippel Lindau protein (VHL) is the E3 ubiquitin ligase that targets HIFs to the proteasome for degradation in normoxia. We have previously demonstrated that the transcription factor HIF-1α is essential for survival and differentiation of growth plate chondrocytes, whereas HIF-2α is not necessary for fetal growth plate development. We have also shown that VHL is important for endochondral bone development, since loss of VHL in chondrocytes causes severe dwarfism. In this study, in order to expand our understanding of the role of VHL in chondrogenesis, we conditionally deleted VHL in mesenchymal progenitors of the limb bud, i.e. in cells not yet committed to the chondrocyte lineage. Deficiency of VHL in limb bud mesenchyme does not alter the timely differentiation of mesenchymal cells into chondrocytes. However, it causes structural collapse of the cartilaginous growth plate as a result of impaired proliferation, delayed terminal differentiation, and ectopic death of chondrocytes. This phenotype is associated to delayed replacement of cartilage by bone. Notably, loss of HIF-2α fully rescues the late formation of the bone marrow cavity in VHL mutant mice, though it does not affect any other detectable abnormality of the VHL mutant growth plates. Our findings demonstrate that VHL regulates bone morphogenesis as its loss considerably alters size, shape and overall development of the skeletal elements

The HIF Signaling Pathway in Osteoblasts Directly Modulates Erythropoiesis through the Production of EPO

SummaryOsteoblasts are an important component of the hematopoietic microenvironment in bone. However, the mechanisms by which osteoblasts control hematopoiesis remain unknown. We show that augmented HIF signaling in osteoprogenitors results in HSC niche expansion associated with selective expansion of the erythroid lineage. Increased red blood cell production occurred in an EPO-dependent manner with increased EPO expression in bone and suppressed EPO expression in the kidney. In contrast, inactivation of HIF in osteoprogenitors reduced EPO expression in bone. Importantly, augmented HIF activity in osteoprogenitors protected mice from stress-induced anemia. Pharmacologic or genetic inhibition of prolyl hydroxylases1/2/3 in osteoprogenitors elevated EPO expression in bone and increased hematocrit. These data reveal an unexpected role for osteoblasts in the production of EPO and modulation of erythropoiesis. Furthermore, these studies demonstrate a molecular role for osteoblastic PHD/VHL/HIF signaling that can be targeted to elevate both HSCs and erythroid progenitors in the local hematopoietic microenvironment.PaperCli

About the importance of being desulfated

Sulfated proteoglycans have important structural and signaling functions in the growth plate. In the October 1, 2008, issue of Genes & Development, Settembre and colleagues (2645–2650) report that lack of SUMF1, a crucial enzyme in the activation of sulfatases, causes a severe chondrodysplasia by augmenting fibroblast growth factor signaling and by hampering the autophagic process, which the investigators show is constitutively on in chondrocytes. The findings highlight the essential role of desulfation in cartilage biology and organogenesis

Merge to emerge - An interdisciplinary approach for management of periodontally compromised orthodontically treated patient

In the modern day dental practice, synergy is fundamental. This synergistic effect must exist among various disciplines of dentistry for proper diagnosis, treatment planning, sequencing and execution of treatment in complex and challenging dental situations. Such collaborative effect between an orthodontist and a periodontist is essential as both works with same element, the tooth as crown-root unit with its supporting tissues. The orthodontic treatment is carried out through the medium of periodontium, so a healthy tooth supporting system is an essential prerequisite. Every potential candidate for orthodontic treatment should undergo a thorough periodontal examination. Any lousily diagnosed or conducted orthodontic treatment could be a facilitator of periodontal inflammatory or infectious process especially when the patient's oral hygiene is explicitly deficient. This case report demonstrates a challenging situation to a periodontist where patient had completed her orthodontic treatment but ended up with severe periodontal disease. The patient was thoroughly examined and a comprehensive treatment was planned and executed. Regenerative surgical procedures were done using platelet rich fibrin and hydroxyapitatite bone graft. Patient was followed up for 2 years. As sequelae of surgical procedures, patient had developed black triangles in the anterior region. The patient was unwilling for further perioplastic surgical procedures and further orthodontic treatment, so a gingival prosthesis using valplast was fabricated addressing her esthetic concerns

Short term outcomes and unintended benefits of establishing a HPB program at a university-affiliated community hospital.

BACKGROUND: In hepato-pancreato-biliary (HPB) surgery higher volumes are associated with improved outcomes; however, there are limitations to regionalization. Here we report our experience establishing multidisciplinary HPB program at a university-affiliated community hospital. METHODS: This is a retrospective review of patients who underwent HPB surgery between 2015 and 2017. Chief residents\u27 HPB case logs were collected. RESULTS: 61 pancreatic resections and 62 hepatic resections were performed. The morbidity, 30-day mortality and median length of stay following pancreatic resections were 27%, 1.5%, and 8 days, respectively. The morbidity, 90-day mortality, and median length of stay following hepatic resections were 24%, 3%, and 7 days, respectively. The median pancreatic and liver case volumes for graduating chief residents increased from 7 to 8 to 16 and 16, respectively (p \u3c 0.05), after the establishment of a HPB program. Participation in multidisciplinary care (p = 0.08) and clinical trial enrollment increased. CONCLUSION: Our study demonstrates short-term outcomes comparable to high volume centers. Development of a HPB program had a positive impact on resident operative experience, increased multidisciplinary care and increased clinical trial enrollment