A study of maternal mortality due to non-obstetric causes

Background: Pregnancy, although being considered a physiological state, carries the risk of serious maternal morbidity and at times mortality, due to various complications that may arise during pregnancy, labour or thereafter. The existing medical condition, infection, and surgical condition which is collectively called as non- obstetric cause pre disposes a women for more complication than a non-pregnant women, so much so that it can lead to maternal mortality. Thus, Pregnancy is more vulnerable state and present study was carried out to study, analyse and review various non-obstetrics causes of death of women during pregnancy or within 42 days of termination of pregnancy in Tertiary care centre.Methods: This was an Observational study, conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached with medical college, from October 2016 to October 2018. The details of maternal deaths were collected from various departments with non- obstetric causes and analyzed.Results: The total number of deliveries in my study period was 15,208. There were 197 maternal mortality in our study period, of which 51 women died of non-obstetric causes. The most common cause of maternal mortality in our study was hepatic cause i.e. 33.33% amongst which viral hepatitis was the most common cause followed by respiratory (19.60%), infectious (15.18%), heamoglobinopathy (13.72%), cardiac (5.88%), neurological (5.88%), surgical (5.88%) causes.Conclusions: Looking into our study, maternal mortality can be reduced by identifying various different indirect medical causes which are preventable by proper pre-pregnancy evaluation for pre-existing comorbid conditions

A comparative study of low dose magnesium sulphate therapy with Pritchard’s regime in management of Eclampsia

Background: Eclampsia is one of the most common causes of maternal and perinatal mortality and morbidity in India. Amongst the principles of management of eclampsia, the first is the control of convulsions. Magnesium sulphate is the main stay of treatment in eclampsia and imminent eclampsia. Average weight of Indian women is less than the western women due to which lower dose of magnesium sulphate can be used.  The aim of the study was to compare the efficacy of low dose magnesium sulphate regimen with standard Pritchard regimen in control of eclampsia.Methods: The study was carried out at emergency labour room, GMERS Sola Civil Hospital Ahmedabad. 120 patients of eclampsia were divided randomly into study group (n=60) receiving low dose MgSO4 and control group (n=60) receiving Pritchard regimen. The recurrence of convulsion, toxicity of MgSO4 and maternal and fetal outcome was studied.Results: It was observed that with low dose MgSO4 regime, convulsions were controlled in 91.7% of the cases. With standard Pritchard’s regime convulsions were controlled in 95% of patients. The maternal and perinatal mortality and morbidity were comparable in both groups.Conclusions: Low dose magnesium sulphate therapy is as effective as Pritchard’s regime for controlling convulsions in eclampsia and can be safely given in Indian women.

Impact of FLAMM scoring on cesarean section rate in previous one lower segment cesarean section patient

Background: The aim of this study was to evaluate the impact of Flamm scoring for Successful VBAC (vaginal birth after cesarean) and Failed TOLAC (Emergency cesarean section) in case of previous one lower segment cesarean delivery.Methods: This is prospective observation study. Out of 150, 111 patients gave consent for TOLAC. 111 patients with previous one caesarean section with gestational weeks between 37 to 40 weeks with spontaneous onset of labour admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital over a period of 1 year from April 2014 to April 2015.Results: In the present study, 111 (74%) patients had undergone TOLAC trial. Out of 111, 77(69.36%) patients had successful VBAC whereas 34 (30.63%) had emergency cesarean. Among the successful VBAC, 7 patients had assisted vaginal delivery to cut short the second stage in prolonged labour. 26% patients refused to give consent for TOLAC from total number of patients in this study. Mean FLAMM score for Successful VBAC was 5.35 (95% CI, 3.9 to 6.7) compared to Failed TOLAC (EME CS) was 3.62 (95% CI, 3.27 to 4.57) Chances of success of TOLAC was increased with increasing FLAMM score according to this study.Conclusions: Application of FLAMM scoring gives fare judgment of successful vaginal birth in TOLAC. So FLAMM scoring can be applied in each previous one lower segment cesarean section patient undergoing TOLAC without increasing morbidity. Practice of protocol of applying FLAMM score and monitoring by partogram will reduce the rate of cesarean section in previous one lower segment cesarean section patient

The association between isolated oligohydramnios at term and pregnancy outcome and perinatal outcome in case of isolated oligohydramnosis: a retrospective analysis

Background: Current study was carried out to assess the impact of isolated oligohydramnios on perinatal outcomes and mode of delivery.Methods: A retrospective observational cohort study was conducted at term pregnancy with sonographic finding of isolated oligohydramnios (AFI 5-25 cm).Results: When compared to the normal AFI, women with oligohydramnios had significantly lower birth weight babies and were delivered at a significantly earlier gestational age. However there was no difference in the APGAR scores at birth and NICU admissions between the two groups. Reactive NST had more chances of good APGAR score at 1 and 5 minute and that lower the AFI more the probability of nonreactive NST and abnormal Doppler. The number of inductions and caesareans done for foetal reasons were significantly higher in the exposed group.Conclusions: Obstetric and perinatal outcome remains similar in both isolated oligohydramnios with reactive NST as well as in patients with normal amniotic fluid index. Isolated oligohydramnios is not associated with adverse perinatal outcomes. However, it increases the risk for labour induction and caesarean section

Towards a better understanding of the full impact of the left digit effect on individual trading behaviour: unearthing a trading profit effect

Investors’ perceptions of price have been shown to be disproportionately affected by the left-most digit(s). However, a similar left digit effect (LDE) in relation to another important determinant of investors’ behaviour (i.e. trading profit) has not been explored. We examine over 7,314,570 million trades made by 25,766 individuals and find a LDE in profit that is 1.71 times stronger than that related to closing price; suggesting that individuals focus more on left digits in profit than price when deciding when to close a trade. In addition, we observe a positive synergistic relationship between the LDE related to profit and price, suggesting that its total influence may result in losses of billions of dollars per financial year for investors. We suggest that these results make a strong case for educating investors against this bias

Ultimate response and plastic design of aluminium alloy continuous beams

Over the last twenty years 6,000 series aluminium alloys are gaining increasing attention as a structural material in the construction sector, particularly in applications where lightness and corrosion resistance are crucial for material selection. Aiming to sustainable construction practices, significant material savings could be achieved through more economical design solutions such as plastic design. Currently, plastic design of aluminium alloy structures is not permitted in most design codes, except European provisions which provide recommendations for inelastic analysis. Indeed, there is a clear lack of experimental data to prove this possibility, particularly for relatively new materials in the construction industry, such as the 6082-Τ6 heat-treated aluminium alloy. To address this knowledge gap, a total of 15 rectangular hollow sections fabricated from 6082-T6 aluminium alloy were tested as simply-supported and two-span continuous beams. Numerical models were developed to replicate the experimental results considering geometric and material nonlinearities. A subsequent parametric study was carried out to generate numerical data for indeterminate structures. One normal and two high strength aluminium alloys as well as two load configurations were examined within this parametric study over a wide range of cross-sectional aspect ratios and slendernesses. The experimental results in combination with the numerical results were utilised to assess the accuracy and applicability of (i) the traditional plastic design method, (ii) the European design provisions (EC9), (iii) the plastic hinge method included in Annex H of EC9, and (iv) the Continuous Strength Method (CSM). Relative comparisons demonstrated the potential of applying plastic design in aluminium alloy indeterminate structures. Notably, the plastic hinge method and the CSM which accounts for strain hardening at the cross-sectional level and for moment redistribution at the system level were found to provide the most accurate design strength predictions, resulting in more economical cross-sections and utilising the full potential of aluminium alloys’ plastic deformability

Design of aluminium alloy channel sections under minor axis bending

In recent years, numerous research works have been reported on the flexural response of aluminium alloy tubular cross-sections. However, studies on monosymmetric cross-sections and particularly channel (C-) sections are limited, albeit their increased usage in structural applications. This paper aims to address this knowledge gap providing an improved understanding about the minor axis bending behaviour of C-sections through an experimental and numerical investigation. In total 14 specimens made from 6082-T6 heat-treated aluminium alloy were subjected to four-point bending. Tensile coupon tests were also performed to determine the mechanical properties of the examined aluminium alloy. The obtained experimental results are analysed and discussed. A series of geometrically and materially nonlinear analyses were also carried out to study the flexural performance of C-sections in two aluminium alloys and two bending orientations over a range of cross-sectional aspect ratios and slendernesses. The experimental and numerical results are utilised to assess the European design standards. The applicability of the Continuous Strength Method and the Direct Strength Method is also evaluated. An alternative design method based on the plastic effective width concept is proposed for slender C-sections subjected to minor axis bending. This method accounts for the inelastic reserve capacity which is in accordance with the experimental and numerical observations

Sustained low-dose treatment with the histone deacetylase inhibitor LBH589 induces terminal differentation of osteosarcoma cells

Histone deacetylase inhibitors (HDACi) were identified nearly four decades ago based on their ability to induce cellular differentiation. However, the clinical development of these compounds as cancer therapies has focused on their capacity to induce apoptosis in hematologic and lymphoid malignancies, often in combination with conventional cytotoxic agents. In many cases, HDACi doses necessary to induce these effects result in significant toxicity. Since osteosarcoma cells express markers of terminal osteoblast differentiation in response to DNA methyltransferase inhibitors, we reasoned that the epigenetic reprogramming capacity of HDACi might be exploited for therapeutic benefit. Here, we show that continuous exposure of osteosarcoma cells to low concentrations of HDACi LBH589 (Panobinostat) over a three-week period induces terminal osteoblast differentiation and irreversible senescence without inducing cell death. Remarkably, transcriptional profiling revealed that HDACi therapy initiated gene signatures characteristic of chondrocyte and adipocyte lineages in addition to marked upregulation of mature osteoblast markers. In a mouse xenograft model, continuous low dose treatment with LBH589 induced a sustained cytostatic response accompanied by induction of mature osteoblast gene expression. These data suggest that the remarkable capacity of osteosarcoma cells to differentiate in response to HDACi therapy could be exploited for therapeutic benefit without inducing systemic toxicity

Status report on the folded tandem ion accelerator at BARC

The folded tandem ion accelerator (FOTIA) facility set up at BARC has become operational. At present, it is used for elemental analysis studies using the Rutherford backscattering technique. The beams of 1H, 7Li, 12C, 16O and 19F have been accelerated up to terminal voltages of about 3 MV and are available for experiments. The terminal voltage is stable within ±2 kV. In this paper, present status of the FOTIA and future plans are discussed

A signal-seeking Phase 2 study of olaparib and durvalumab in advanced solid cancers with homologous recombination repair gene alterations

Purpose: To determine the safety and efficacy of PARP plus PD-L1 inhibition (olaparib + durvalumab, O + D) in patients with advanced solid, predominantly rare cancers harbouring homologous recombination repair (HRR) defects. Patients and methods: In total, 48 patients were treated with O + D, 16 with BRCA1/2 alterations (group 1) and 32 with other select HRR alterations (group 2). Overall, 32 (66%) patients had rare or less common cancers. The primary objective of this single-arm Phase II trial was a progression-free survival rate at 6 months (PFS6). Post hoc exploratory analyses were conducted on archival tumour tissue and serial bloods. Results: The PFS6 rate was 35% and 38% with durable objective tumour responses (OTR) in 3(19%) and 3(9%) in groups 1 and 2, respectively. Rare cancers achieving an OTR included cholangiocarcinoma, perivascular epithelioid cell (PEComa), neuroendocrine, gallbladder and endometrial cancer. O + D was safe, with five serious adverse events related to the study drug(s) in 3 (6%) patients. A higher proportion of CD38 high B cells in the blood and higher CD40 expression in tumour was prognostic of survival. Conclusions: O + D demonstrated no new toxicity concerns and yielded a clinically meaningful PFS6 rate and durable OTRs across several cancers with HRR defects, including rare cancers