Maternal outcome of caesarean section with or without eventration of the uterus: a prospective observational study

Background: Caesarean section is a commonest surgical procedure performed by an obstetrician. Many variations in technique of caesarean section have been devised with the intent of shortening the operating time, making the operation easier, safer and more efficient; and to decrease the blood loss, postoperative morbidity, other complications as well as to shorten the period of hospitalization. One such variation is in the technique of repair of the uterus, whether it is repaired in situ or taken out from the incision and repaired outside the abdomen before replacing it back in place. This study was designed to compare two techniques of uterine closure and determine the benefit of using one technique over the other.Methods: A prospective observational study on 100 women who underwent caesarean section. Technique of uterine repair was surgeon dependent and was not influenced by investigator.  Based on this, patients were assigned into two separate groups (exteriorised group and in situ repair group). Observation was made and recorded regarding the various preoperative, intraoperative parameters and the surgeon`s technique of uterine closure. The patients were then followed up and various postoperative outcome variables were recorded.Results: There were no statistically significant differences between the two groups with regards to any of the intraoperative or postoperative parameters except that there was a rise in diastolic pressure in exteriorization group during eventration which gradually came down during the suturing and reposition (P < 0.05).Conclusions: With this study, it can be concluded that clinical outcomes remain unaffected by any of the two methods of uterine repair. Both are equally safe. However, a caution must be exercised in intraoperative blood pressure monitoring, especially when the uterus is being exteriorized for repair as there is a statistically significant rise in diastolic blood pressure during eventration

In Home Environmental Assessments: A Key Component of a Comprehensive Asthma Management Initiative

Asthma is one of the most common chronic diseases of childhood, and carries a high public health burden. Asthma is more prevalent and more severe in children from minority groups and those of lower socioeconomic status (Akinbami, 2009). Direct and indirect health care costs of asthma in the US total more than $18 billion per year (AAAAI, 2009). Although it is not a curable illness, it can be effectively managed with comprehensive care that includes medical management, education, and environmental modifications. In 2007, national asthma management guidelines were modified to include environmental trigger identification and remediation as a critical component of asthma care. This is based on a growing body of evidence that suggests that reduction of indoor environmental triggers in the home environment of children with asthma may lead to a decrease in asthma-related morbidity and in asthma-related health care costs. A home visit is an optimal setting to provide patient education and to identify and mitigate the effects of environmental triggers in the home. In the last several years, a number of research studies and programs have attempted home-based interventions that provide a combination of tailored home environmental assessments, patient education, and supplies to reduce indoor allergens. Using these experiences as a starting point, Community Care of Wake and Johnston Counties is in the process of developing and implementing an asthma initiative that focuses on indoor environmental trigger reduction through home assessments and case management. This paper will focus on the planning and development of a program and evaluation plan for a multifaceted in home environmental intervention for Wake County children with asthma.Master of Public Healt

A comparative study between magnetic resonance imaging and transvaginal sonography for evaluation of uterine fibroid using histopathology as a gold standard

Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal  and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice

Magnetic resonance studies on the interaction of metal-ion and nucleotide ligands with brain hexokinase

Our previous studies have shown that one manganous ion binds tightly to bovine brain hexokinase, with a Kd =25 &#177; 4 &#956;M. The characteristic proton relaxation rate (PRR) enhancement of this binary complex (&#949;b) 3 .5 at 9 MHz and 23 &#176;C [ Jarori, G. K. Kasturi, S. R., and Kenkare, U. W. (1981) Arch. Biochem. Biophys. 211,258 - 2681. On the basis of PRR enhancement patterns, observed on the addition of nucleotides ATP and ADP to this E . Mn binary complex, we now show the formation of a nucleotide-bridge ternary complex, enzyme . nucleotide . Mn. Addition of glucose 6-phosphate to enzyme . ATP . Mn, results in a competitive displacement of ATP Mn from the enzyme. However, a quaternary complex E &#183; ADP&#183; Mn&#183; Glc-6-P appears to be formed when both the products are present. &#946;, &#947;-Bidentate Cr(II1)ATP has been used to elucidate the role of direct binding of Mn(I1) in catalysis, and the stoichiometry of metal-ion interaction with the enzyme in the presence of nucleotide. Bidentate Cr(II1)ATP serves as a substrate for brain hexokinase without any additional requirement for a divalent cation. However, electron-spin resonance studies on the binding of Mn(I1) to the enzyme in the presence of Cr(I1I)ATP suggest that, in the presence of nucleotide, two metal ions interact with hexokinase, one binding directly to the enzyme and the second interacting via the nucleotide bridge. It is this latter one which participates in catalysis. Experiments carried out with hexokinase spin-labeled with 3-(2-iodo-acetamido)-2,2,5,5-tetramethyl-lpyrrolidinyloxyl clearly showed that the direct-binding Mn site on the enzyme is distinctly located from its ATP Mn binding site

Clobetasol propionate cream 0.025%: a topical therapeutic for dermatological disorders

Due to the anti-inflammatory and vasodilator effects of topical corticosteroids, they help in treating atopic eczema, psoriasis, chronic hand eczema, and localized vitiligo, among other dermatological diseases. Clobetasol propionate (CP) is the most popular topical medication used to treat plaque psoriasis. It has anti-inflammatory, antimitotic, antipruritic, and immunosuppressive characteristics. The USFDA has approved CP 0.025% cream for the treatment of moderate-to-severe psoriasis in adults. Propylene glycol, short-chain alcohols, and sorbitol-based emulsifiers are all recognized contact allergens, and the formulation has exhibited hypoallergenic effects. CP 0.025% is an effective and safe agent due to its high active ingredient penetration and minimal systemic absorption. The clinical experience of employing CP 0.025% cream in diverse dermatologic disorders is discussed in this case series, with a focus on its efficacy and safety

Hypertension guidelines and coronary artery calcification among South Asians: Results from MASALA and MESA

Untreated hypertension may contribute to increased atherosclerotic cardiovascular disease (ASCVD) risk in South Asians (SA). We assessed HTN prevalence among untreated adults free of baseline ASCVD from the MASALA & MESA studies. The proportion of participants who received discordant recommendations regarding antihypertensive pharmacotherapy use by the 2017-ACC/AHA and JNC7 Guidelines across CAC score categories in each race/ethnic group was calculated. Compared with untreated MESA participants (n = 3896), untreated SA (n = 445) were younger (55±8 versus 59±10 years), had higher DBP (73±10 versus 70±10 mmHg), total cholesterol (199±34 versus 196±34 mg/dL), statin use (16% versus 9%) and CAC=0 prevalence (69% versus 58%), with fewer current smokers (3% versus 15%) and lower 10-year-ASCVD-risk (6.4% versus 9.9%) (all p\u3c0.001). A higher proportion of untreated MASALA and MESA participants were diagnosed with hypertension and recommended anti-hypertensive pharmacotherapy according to the ACC/AHA guideline compared to JNC7 (all p\u3c0.001). Overall, discordant BP treatment recommendations were observed in 9% SA, 11% Whites, 15% Blacks, 10% Hispanics, and 9% Chinese-American. In each race/ethnic group, the proportion of participants receiving discordant recommendation increased across CAC groups (all p\u3c0.05), however was highest among SA (40% of participants). Similar to other race/ethnicities, a higher proportion of SA are recommended anti-hypertensive pharmacotherapy by ACC/AHA as compared with JNC7 guidelines. The increase was higher among those with CAC\u3e100 and thus may be better at informing hypertension management in American South Asians

Identification and management of atherosclerotic cardiovascular disease risk in south Asian populations in the U.S.

South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population

Rapid and sensitive detection of mycotoxins by advanced and emerging analytical methods: A review

Quantification of mycotoxins in foodstuffs is extremely difficult as a limited amount of toxins are known to be presented in the food samples. Mycotoxins are secondary toxic metabolites, made primarily by fungal species, contaminating feeds and foods. Due to the presence in globally used grains, it is an unpreventable problem that causes various acute and chronic impacts on human and animal health. Over the previous few years, however, progress has been made in mycotoxin analysis studies. Easier techniques of sample cleanup and advanced chromatographic approaches have been developed, primarily high-performance liquid chromatography. Few extremely sophisticated and adaptable tools such as high-resolution mass spectrometry and gas chromatography–tandem MS/MS have become more important. In addition, Immunoassay, Advanced quantitative techniques are now globally accepted for mycotoxin analysis. Thus, this review summarizes these traditional and highly advance methods and their characteristics for evaluating mycotoxins

CORRELATION OF ANTIOXIDANT AND ANTIPROLIFERATIVE ACTIVITY OF AMLA AND GINGER

Objective: Our study focused on evaluating the anticancer property of ascorbic acid and aqueous extract of amla and ginger.Methods: Antioxidant capacity of ascorbic acid, aqueous extract of amla, and ginger was obtained by 2,2-diphenyl-1-picrylhydrazyl method and total antioxidant capacity (TAC). Vero cell line, PA-1, Cal-27, Cal-27 CisR, and DysMSCTR16 cell lines were treated with antioxidants to evaluate its antiproliferative property using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Colony and spheroid formation assays were also carried out in the presence of extracts to assess its role in anticancer stem cell activity.Results: Two volumes of amla 5 μl (~0.016 g) and 25 μl (~0.08 g) and ginger 5 μl (~0.02 g) and 25 μl (~0.1 g) showed TAC activity equivalent to 0.25 mM and 2 mM ascorbic acid, respectively. Amla and ascorbic acid showed significant antiproliferative property in normal (Vero) p=0.05, cancer (PA-1, Cal-27) p=0.005, and resistant (Cal-27 CisR) p=0.05 cell lines and ginger extract in Vero and Cal-27 cell lines (p=0.05). In PA-1 and Cal-27 CisR cell line, ginger extract showed proliferative activity (p=0.005). Antioxidants showed no antiproliferative activity in DysMSCTR16 cells. Amla extract and ascorbic acid showed significant inhibitory effect on spheroid (p=0.005) and colony formation capacity (p=0.0005) among dysplastic, cancer, and resistant cell lines. Ginger showed inhibitory effect (p=0.05) only in colony formation capacity.Conclusion: Overall, we found a strong correlation between antioxidant and antiproliferative activity of ascorbic acid, amla, and ginger. Amla and ascorbic acid proved to be effective in controlling cell proliferation and self-renewal properties of cancer cells. However, ginger was found to have selective and less antiproliferative effect in comparison to amla