Classification of cesarean section through Robson criteria: an emerging concept to audit the increasing cesarean section rate

Background: There has been an increase in rate of cesarean section over last five decades. This is a matter of international public health concern as it increases the cesarean section related maternal morbidity. The aim of the present study was to audit the increasing rate of caesarean section.Methods: In the present study, all cases delivered by cesarean section during the period of six months were recorded and classified according to Robson's 10 group classification system. This was an attempt to see which clinically relevant groups contributed most to the cesarean deliveries.Results: There was a trend of increased percentage of cesarean section in group 5 and 2 respectively in present study. Increasingly sedentary lifestyle and poor tolerance to pain are adding to cesarean delivery on maternal request.Conclusions: We should judiciously make use of vaginal birth after cesarean section but not at the cost of maternal or fetal health. Standardization of indication of cesarean deliveries, regular audits and definite protocols in                                                                                                                                                                                                                                                                                                                                 hospital will aid in curbing the rate of cesarean deliveries in hospitals

A comparative study of subcuticular and interrupted stitches for episiotomy

Background: Perineal pain is the most common complaint after episiotomy. For more than 70 years researchers have been suggesting that ‘continuous non-locking suture techniques’ for repair of the vagina, perineal muscle and skin are associated with less perineal pain than ‘traditional interrupted methods’. The objective of the present study was to compare the two techniques of episiotomy closure in patients after vaginal delivery with mediolateral episiotomy.Methods: This study was conducted in the Department of Obstetrics and Gynecology, Asian Institute of medical sciences, Faridabad. The duration of study was from July 2017 to August 2017. Total 50 patients were selected and randomly divided in two groups. This was a prospective comparative study between continuous and interrupted suturing used for episiotomy repair.Results: Continuous suturing technique requires lesser number of suture material, needs lesser time and is associated with lesser pain experience.Conclusions: It was concluded from the present study that continuous suturing technique is more economical and causes lesser morbidity than the interrupted suturing technique

Dynamics of contraceptive use among women attending multi-speciality hospital in Faridabad district of Haryana

Background: Population of India is growing at a very fast rate while its resources are limited which will lead to decrease in per capita availability of resources. Contraceptive methods are the simplest way to address this issue of population explosion by preventing the unwanted pregnancies. The objective of this study was to assess awareness and practices regarding contraceptive use and its determinants among women attending gynecology OPD of multi-specialty hospital in Faridabad district of Haryana.  Methods: A cross-sectional study was planned among 200 patients from gynecology OPD in a multi-specialty hospital of Faridabad district of Haryana. The questionnaire consisted of questions about socio-demographic data and data related contractive awareness and practices. Data was analyzed by SPSS software version 21.0.Results: Mean age of study subjects was 29.4±4.3 years. Out of 200 participants, about one fourth (77.5%) were aware about contraception and more than half (59.5%) of them were using contraception methods. Factors like age and education status, occupation and area of residence were found to be statistically significantly (p<0.001) associated with contraception knowledge and practice. Barrier method was most common method of contraception followed by Oral contraceptive pills.Conclusions: This study concludes that knowledge about contraception was high as about one fourth (77.5%) were aware about contraception while practice of contraception was relatively low as compare to knowledge as two fifth (40.5%) of them were not using any contraception methods. So, there is a need to increase awareness about importance of contraception practice among study population

Conjoined Twins with a Single Heart

A case of abdomino-thoracopagus twins with single heart is described. The male twins were delivered in the 15th week of gestation following the desire of the parents to terminate pregnancy. This case is of particular interest because of the rarity of the abdomino-thoracopagus twins with a single heart, in the literature, that too, of male conjoined twins

Interaction of the chromatin remodeling protein hINO80 with DNA

The presence of a highly conserved DNA binding domain in INO80 subfamily predicted that INO80 directly interacts with DNA and we demonstrated its DNA binding activity in vitro. Here we report the consensus motif recognized by the DBINO domain identified by SELEX method and demonstrate the specific interaction of INO80 with the consensus motif. We show that INO80 significantly down regulates the reporter gene expression through its binding motif, and the repression is dependent on the presence of INO80 but not YY1 in the cell. The interaction is lost if specific residues within the consensus motif are altered. We identify a large number of potential target sites of INO80 in the human genome through in silico analysis that can grouped into three classes; sites that contain the recognition sequence for INO80 and YY1, only YY1 and only INO80. We demonstrate the binding of INO80 to a representative set of sites in HEK cells and the correlated repressive histone modifications around the binding motif. In the light of the role of INO80 in homeotic gene regulation in Drosophila as an Enhancer of trithorax and polycomb protein (ETP) that can modify the effect of both repressive complexes like polycomb as well as the activating complex like trithorax, it remains to be seen if INO80 can act as a recruiter of chromatin modifying complexes

Localization of INO80 and histone marks in the upstream regions.

<p>The data from ChIP followed by qPCR for HOXC11(A & B) and PAX7(C & D) are shown. A & C- Line diagram indicates the upstream region analyzed by qPCR of ChIP DNA (thick black line) mapping on chromosome12 and 1 respectively for <i>HOXC11</i> and <i>PAX7</i>, along with the genomic positions; the bent arrow indicates the direction of transcription of the gene, and unfilled box is the hINO80 binding motif present in the upstream region. HC1-HC6 and PX1-8 are the amplicons originating from the upstream region covering 1137bp and 1403bp of HOXC11 and PAX7 respectively using primers listed (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0159370#pone.0159370.s007" target="_blank">S2B Table</a>). B&D show the enrichment as % Input for each region HC1-HB6(B) and PX1-PX8 (C) of INO80 and the H3K9me3 and K3K27me3 marks as shown in the inset (*p value<0.05 and **p<0.001 in comparison with IgG for each primer set).</p

Competitive EMSA with the mutant oligos.

<p>(A) List of mutant oligos used in the assays, (B) Results of competitive EMSA with mutant oligos at the indicated ratio, (C) Densitometric scan of gel shown in B. The intensity value of the band (shown by arrow) in the lanes shown in (B), normalized to band at the same position in lane 2, are plotted on the Y-axis. Three different ratios for each competing oligo were used as indicated in B and the mutant sequence used is mentioned below the histogram.</p

<i>In vivo</i> interaction of INO80 on predicted gene targets.

<p>(A) A line diagram for the region 2Kb upstream of HOXC11 gene is shown as the example of the region analyzed by ChIP. The filled rectangle denotes the INO80 binding motif and the position of the primers (arrows) are marked. (B) ChIP-PCR results for the indicated genes on the human genome. The interaction of INO80 protein was examined in the upstream sequences of these genes using INO80 antibody in HEK293T cells. IgG antibody was used as the negative control for ChIP experiment. The negative (-ve) and positive (+ve) indicate the PCR controls. Input is 20% of sonicated chromatin. (C) Quantitative PCR for putative INO80 targets following ChIP assay in HEK293T cells. The Y axis shows the enrichment as percentage input observed. NAT2 and PSEN lack the INO80 binding motif. (*p value<0.05, **p value<0.001 Two tailed Student t-test)</p

Interaction of INO80 binding motif with nuclear extract from HEK 293T cells.

<p>Results of EMSA with Cy3 labeled specific oligo at ratio of 1:5 in all the experiments. The unlabeled competing oligos both specific(A) and non-specific(B) were varied at different molar ratios as indicated at the top of the lanes. The arrow heads indicate the three retarded oligo nucleotides.</p

<i>In vivo</i> localization of INO80 in the upstream regions of its target genes.

<p>The data from ChIP followed by qPCR for HOXB13 (A & B) and HOXD4 (C & D) are shown. A & C- Line diagram indicating the upstream region analysed by qPCR of ChIP DNA as thick black line mapping on chromosome17 and 2 for HoxB13 and HoxD4 respectively along with the genomic positions, the bent arrow indicates the direction of transcription of the gene, unfilled box is the hINO80 binding motif present in the upstream region. HB1-HB5 and HD1-5 are the amplicons originating from the upstream region covering 884bp and 888bp of HoxB13 and HoxD4 respectively using primers listed (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0159370#pone.0159370.s007" target="_blank">S2B Table</a>). B&D show the enrichment as % Input for each region HB1-HB5 (B) and HD1-HD3(C), (*p value<0.05 and **p<0.001 in comparison with IgG for each primer set).</p