Patterns and causes of maternal mortality in tertiary care hospital in Maharashtra, India: a 10-year retrospective study

Background: Maternal death is a catastrophe, as death of a mother can the entire family. The aim of present study is to find out major patterns, reasons and complications leading to maternal deaths. Methods: A retrospective study was conducted for last 10 years from January 2013 to December 2022 by studying the records of a tertiary care hospital to study the maternal mortalities and complications leading to death. Maternal deaths were analyzed by considering different facets, such as age at death, gravida, locality of residence, admission death interval and direct and indirect cause/s of death, etc. Results: During the study period, total of 107753 live births and 202 maternal deaths have been recorded. The average maternal mortality rate of last ten years was 187.46/100000 live births. Age wise maternal mortality during the study period was high in the age 19 to 25. Major direct cause of maternal mortality was postpartum hemorrhage, (23%) and major indirect cause observed was anemia (43%). Admission to death interval time indicates that delay in provision of treatment and referral to tertiary care hospital might be the reason responsible for high maternal deaths. Conclusions: Maternal deaths can be prevented by improving the health care facilities, ensuring skilled attendants and required basic medication. This is high time to mobilize universal, national, regional, and community-based commitment to decrease maternal mortalities.

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Comparison of shear bond strength of aesthetic restorative materials

Aim : The present study was conducted to determine and compare the shear bond strengths of Conventional glass ionomer; Resin-modified glass ionomer; Polyacid-modified composite and Composite Resin, and to assess and determine the mode of failure (adhesive, cohesive, mixed). Materials and Methods : Occlusal dentin of 40 extracted human teeth were randomly divided into four groups of ten teeth, each based on the restorative materials tested as follows: Group I: Conventional Glass Ionomer Cement (Control); Group II: Resin-modified Glass Ionomer Cement; Group III: Polyacid-modified Composite Resin; Group IV: Hybrid Composite Resin. The bonded materials were subjected to shear bond strength (SBS) testing in a Instron Universal Testing Machine (UTM) at a crosshead speed of 0.5 mm/min. The bond failure location was examined by the use of a stereomicroscope at 10× magnification. The mean SBS of Groups I-IV obtained was 3.81, 9.71, 11.96 and 18.16 MPa, respectively. Comparison of mean shear bond strengths of all groups was done by one way ANOVA test and comparison of means in between groups by the Student′s t test. Conclusion : It is concluded that the compomer restorative materials show higher shear bond strength than conventional glass-ionomer and resin-modified glass-ionomer, but less than composite resin

Underground Water Analysis Of Butibori Area (Nagpur)

Water quality information is needed to assess the state of water contamination in a variety of community, including those that rely primarily on unimproved underground sources of drinking water. The study will be carried out to assess the quality of groundwater in particular sites of the domestic area of Butibori. The groundwater samples will be collected from a shallow well, tube well and bore wells located at specific places within the domestic area of Butibori. The research was focused on the physicochemical and bacteriological analysis of underground water from domestic sites