Assessing the safety and efficacy of dinoprostone vaginal insert in pregnancy

Background: Induction of labor (IOL) is a procedure used to achieve vaginal birth when the hazards of extending the pregnancy for either the mother or the infant outweigh the dangers of delivery. It is often used in high-risk pregnancies, although it can also be useful in low-risk groups, as demonstrated by A Randomized Trial of Induction Versus Expectant Management (ARRIVE) study. Methods: The cross-sectional study was conducted among 414 patients at Department of Obstetrics and Gynaecology tertiary care hospital. The study was conducted for one-year duration in pregnant women with maternal age >18 years, gestational week >37 weeks, and Bishop score <7 was included in the study with no signs of labor. Demographic details such as age, pregnancy history, and mode of delivery were recorded for comparison. Patients with no induction of labor were administered misoprostol and/or dinoprostone based on clinical conditions with further evaluation of maternal complications, delivery time, birthweight of the fetus, and fetal heart rate. Data were analyzed based on percentages and a chi-square test was used (p-value <0.05). Results: The mode of delivery did not significantly affect delivery outcomes (p=0.354), with assisted delivery being the most common (35.41%). Indication for induction was found to be significant (p=0.034), with non-progress of labor being the most common indication (55.2%). Maternal complications were not significantly associated with delivery outcomes (p=0.390), with 60 (14.49%) patients experiencing complications. The use of misoprostol reported a significant difference between modes of delivery with 74.93% of vaginal delivery, 19.47% with lower segment cesarean section (LSCS), and 5.60% with assisted delivery (p value <0.03). Conclusions: In low-risk pregnant women, the dinoprostone or misoprostol vaginal inserts are both safe and effective for inducing labor. Nulliparous individuals and those who did not get epidural analgesia during labor had a higher chance of caesarean section

Evaluation of the efficacy and tolerability of 4 mg dienogest in women with adenomyosis and BMI >30

Background: To evaluate the efficacy and tolerability of 4mg dienogest in women with adenomyosis and BMI >30. Methods: This prospective study, conducted at Lakshmi Madhavan Hospital Pvt Ltd, Tirunelveli, Tamil Nadu, between January and October 2023, included 110 women aged 30-40 years diagnosed with adenomyosis via ultrasonography and presenting with severe dysmenorrhea. These women, all with BMI >30, were administered 4mg Dienogest (2mg twice daily) for eight weeks, followed by a taper to 2mg once daily for 12 weeks. All participants received dietary counselling emphasizing reduced carbohydrate intake and lifestyle modifications. Data on symptom improvement, adverse effects, and adherence were collected and analyzed using STATA 11.0. Results: A significant improvement in symptoms such as menorrhagia, dysmenorrhea, dyspareunia, and chronic pelvic pain was observed in 81% of participants. Adverse effects, including headache (15%), breast discomfort (10%), and mild weight gain (8%), were reported but were well-tolerated. Irregular bleeding led to discontinuation in 3% of cases. Women requiring the 4mg dose beyond eight weeks demonstrated poor adherence to dietary modifications. The overall success rate was 81% (n=89), with a failure rate of 19% (n=21). Conclusion: The study suggests that a higher dosage of Dienogest (4mg) for a limited period is effective and well-tolerated in obese women with adenomyosis who do not respond to the standard 2 mg dose. However, individualized treatment and strict lifestyle adherence are essential for optimal outcomes

Influence of polyamines on shoot regeneration of sugarcane (Saccharum officinalis. L)

We studied the effect of polyamines (spermidine, putrescine and spermine) along with benzyladenine, kinetin and napthaleneacetic acid on multiple shoot regeneration of sugarcane. Murashige & Skoog medium containing a combination of benzyladenine (8.3 μM), kinetin (4.6 μM), napthaleneacetic acid (2.6 μM) and spermidine (68 μM) induced the maximum number of shoots (42 shoots/explant) compared to benzyladenine (8.3 μM), kinetin (4.6 μM) or napthaleneacetic acid (2.6 μM) alone or with putrecine (68 μM), spermine (32 μM) or combinations of polyamines. Plantlets raised were successfully transplanted in soil with a 90% survival rate

A Singular Perturbation Based Midcourse Guidance Law for Realistic Air-to-Air Engagement

In this study, a singular perturbation based technique is used for synthesis and analysis of a near optimal midcourse guidance law for realistic air-to-air engagement. After designing the proposed midcourse guidance law using three dimensional point mass formulation it has been validated through detailed realistic six degrees of freedom simulation. During terminal phase only proportional navigation guidance have been used. The calculation of optimal altitude in present guidance law has been carried out using Newton’s method, which needs generally one iteration for convergence and suitable for real-time implementation. Extended Kalman filter based estimator has been used for obtaining evader kinetic information from both radar and seeker noisy measurements available during midcourse and terminal guidance. The data link look angle constraint due to hardware limitation which affects the performance of midcourse guidance has also been incorporated in guidance law design. Robustness of complete simulation has been carried out through Monte Carlo studies. Extension of launch boundary due to singular perturbation over proportional navigation guidance at a given altitude for a typical engagement has also been reported

Trajectory Optimisation of Long Range and Air-to-Air Tactical Flight Vehicles

This paper presents formulation and solution of long range flight vehicle and tactical air-to-air flight vehicle trajectory optimisation. The first case study is of a long range flight vehicle. Here an optimum steering program during powered phase has been evolved as control input for achieving maximum range with available propulsions in the presence of path and terminal constraints. The second case study is of a tactical flight vehicle for air-to-air application. Here a minimum flight time trajectory has been generated for covering a specified range pertaining to a specified air-to-air engagement by evolving pitch lateral acceleration as control input. Here also, there are many path and terminal constraints consisting of launch aircraft, pursuer, and evader. The studies have been carried out as part of system design activity of both flight vehicles. Both are real-life optimisation problems under several constraints. Through it is very difficult to solve such practical problems in flight dynamics using classical optimal control theory, it has been solved successfully using direct transcription method based on nonlinear programming. Rapid convergence has been achieved in four passes with minimum grids in first pass, to start with, and increasing the grids in subsequent passes. Solving such a real-life problem with proper convergence subjected to many constraints is claimed as novelty of present research.Defence Science Journal, Vol. 65, No. 2, March 2015, pp.107-118, DOI:http://dx.doi.org/10.14429/dsj.65.823

A study on prevalence and co-morbidity of bipolar and anxiety disorders in chronic headache patients

Background: Co morbidity between headache and psychiatric disorders is more prevalent in chronic headache patients. The bipolar disorders and anxiety disorders are predominant in migraine and TTH respectively. This co morbidities have a poor reflection and impact on quality and outcome of chronic headache patients and results in worst prognosis and poor response to medical treatment.Methods: The chronic headache patients especially migraine and tension type of headache were analyzed with following materials such as the structured psychiatric clinical interview with ICD-10 mental and behavioural disorder, DSM-5 criteria. HAM-A, HAM-D, BDI-2, BPRS, young mania rating scale, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and panic disorder scale.Results: Various subsets of bipolar disorder and anxiety disorder were found as follows: 74% of migraineurs are associated with psychiatric disorders in which bipolar affective disorder 6%, depressive episode 48%, dysthymia 30%, GAD 10% and Panic disorder 6%. 52% of TTH are associated with psychiatric disorders as follows: major depressive episode 52%, GAD 30%, separation anxiety disorder 6%, PTSD 7%, OCD 3% and panic disorder 2%.Conclusions: From previous and future studies the headache can be identified according to subsets of headache with psychiatric disorders make easier to provide appropriate pharmacological and psychological treatment which may reduce the chronicity and intractability of headache

Changing indications and socio-demographic determinants of (adeno)tonsillectomy among children in England--are they linked? A retrospective analysis of hospital data.

OBJECTIVE: To assess whether increased awareness and diagnosis of obstructive sleep apnoea syndrome (OSAS) and national guidance on tonsillectomy for recurrent tonsillitis have influenced the socio-demographic profile of children who underwent tonsillectomy over the last decade. METHOD: Retrospective time-trends study of Hospital Episodes Statistics data. We examined the age, sex and deprivation level, alongside OSAS diagnoses, among children aged <16 years who underwent (adeno)tonsillectomy in England between 2001/2 and 2011/12. RESULTS: Among children aged <16 years, there were 29,697 and 27,732 (adeno)tonsillectomies performed in 2001/2 and 2011/12, respectively. The median age at (adeno)tonsillectomy decreased from 7 (IQR: 5-11) to 5 (IQR: 4-9) years over the decade. (Adeno)tonsillectomy rates among children aged 4-15 years decreased by 14% from 350 (95%CI: 346-354) in 2001/2 to 300 (95%CI: 296-303) per 100,000 children in 2011/12. However, (adeno)tonsillectomy rates among children aged <4 years increased by 58% from 135 (95%CI: 131-140) to 213 (95%CI 208-219) per 100,000 children in 2001/2 and 2011/2, respectively. OSAS diagnoses among children aged <4 years who underwent surgery increased from 18% to 39% between these study years and the proportion of children aged <4 years with OSAS from the most deprived areas increased from 5% to 12%, respectively. CONCLUSIONS: (Adeno)tonsillectomy rates declined among children aged 4-15 years, which reflects national guidelines recommending the restriction of the operation to children with more severe recurrent throat infections. However, (adeno)tonsillectomy rates among pre-school children substantially increased over the past decade and one in five children undergoing the operation was aged <4 years in 2011/12.The increase in surgery rates in younger children is likely to have been driven by increased awareness and detection of OSAS, particularly among children from the most deprived areas

Knowledge, attitude and practice of insulin use and its adverse effects in adult diabetic population

Background: Diabetes is a disease when left untreated, leads to many complications. India is emerging as a diabetic capital of the world. Insulin is widely used as a therapeutic option, and hence this study was conducted to assess the awareness of Insulin use and its adverse effects in diabetic population.Methods: The study was a questionnaire survey conducted in adult patients with diabetes who are on Insulin therapy. The participants’ knowledge, attitude and practice were assessed by using a questionnaire consisting of 32 questions. Scores were allotted to each question, and evaluated after applying appropriate statistical tests.Results: The mean age of the participants was 57.26±11.24 years. About 54% were males. 46% belonged to rural areas. The mean knowledge score was 17.53±4.40, mean attitude score 7.42±4.85 and the mean practice score was 6.56±1.91. 40% responded that they will return the expired insulin vials to the pharmacy. The most common reason for non adherence was economical constraints (60%). The females had better knowledge (17.60±4.43 vs. 17.45±4.40, p>0.88), attitude (8.21±3.84 vs. 6.58±5.56, p>0.09) and practice (6.97±1.84 vs. 6.13±1.92, p0.297), attitude (8.70±3.95 vs. 6.06±5.37, p 1.395) than the rural counterparts.Conclusions: There exists a gap between knowledge attitude and practice of insulin use. This can be overcome by conducting awareness programmes by health care providers, to sensitise people about the proper use, side effects and the methods of disposal of insulin vials

Enhanced Singular Value Decomposition based Fusion for Super Resolution Image Reconstruction

The singular value decomposition (SVD) plays a very important role in the field of image processing for applications such as feature extraction, image compression, etc. The main objective is to enhance the resolution of the image based on Singular Value Decomposition. The original image and the subsequent sub-pixel shifted image, subjected to image registration is transferred to SVD domain. An enhanced method of choosing the singular values from the SVD domain images to reconstruct a high resolution image using fusion techniques is proposesed. This technique is called as enhanced SVD based fusion. Significant improvement in the performance is observed by applying enhanced SVD method preceding the various interpolation methods which are incorporated. The technique has high advantage and computationally fast which is most needed for satellite imaging, high definition television broadcasting, medical imaging diagnosis, military surveillance, remote sensing etc