Prevention of Ovarian Hyper stimulation Syndrome by using gonadotrophic releasing hormone analogue to induce final ovulation trigger in invitro fertilization cycles

Objectives: To find out occurrence of ovarian hyperstimulation in patients who were hyper responders in in vitro fertilization cycles. Secondary outcome was to assess number of metaphase II oocyte and fertilization rate, cleavage rate and pregnancy outcome when GnRHa is used for final maturation and triggering ovulation. STUDY DESIGN, SIZE, and DURATION: This is retrospective descriptive analysis of cases managed at single center from June 2017 till May 2018. PATIENTS & METHODS: Twenty patients were identified as hyper responders based on baseline, ovarian reserve characteristics, that is antral follicle count, (AFC) > 25, AMH > 4ng/ml and on day  of  trigger,  follicles  >-25  in  number  of  ≥  11mm  were administered GnRHa trigger and 1500IU hCG on oocyte retrieval day while luteal phase was supported with daily vaginal  progesterone and twice daily estradiol valerate. Sixteen patients underwent fresh transfer while four patients had their embryos frozen. MAIN RESULTS: Twenty patients were identified as high risk and their baseline characteristics were, mean age 31.7 ± 4.50, mean antral follicle count 25.7 ± 5.01, Anti Mullerian hormone level mean 4.64 ± 2.52 and PCOS was present in 35% cases. Peak estradiol level mean 13455-± 6632pmol/l and mean follicles count of 25.45 ± 8.78 confirmed a high response. Oocyte yield was 11.45+ Metaphase oocyte retrieved were 85.5% and cleavage rate of 93%. No case of early onset OHSS was identified. Only one patient developed moderate OHSS. Pregnancy rate was 31.25%. Miscarriage rate was 6.3% and ongoing pregnancy was 25%. CONCLUSION:  This small retrospective descriptive analysis supports the view of current literature that GnRH trigger not only prevents early onset OHSS also achieves increase of M11 oocytes. In addition, pregnancy outcome is not statistically different to those cycles where hCG is used as trigger.

Appraisement of the Pernicious Status of Drinking Water Exposed to Precambrian Rocks of Chenab Nagar Area, Punjab, Pakistan

Natural and anthropogenic indulgence in the form of industrialization, urban sprawl, and population increase deplete the water resources that entails immediate consideration. So, contemplating this need for eco-rehabilitation, drinking water quality predicted in contemporary research for surface and groundwater in proximity of Precambrian rocks (Chenab Nagar, Punjab) revealed poor water quality status. Physical parameters (EC, TDS, and temperature), chemical (pH, carbonates, bicarbonates, chlorides, and heavy metals) and microbiological (total coliforms, fecal coliforms, and the absence or occurrence of E. coli) distinctiveness of water were determined in forty-two samples, collected from study area. The mean values of pH, EC, TDS, carbonates, bicarbonates, chlorides, and temperature for water samples fluctuated discretely in all months. Likewise, heavy metals depicted an increasing trend as the concentration of cadmium and lead was high among all analyzed metals. Microbiological study shows that large number of the samples had elevated concentration of fecal coliforms and E. coli bacteria thus making water harmful for human consumption

Hypertension-related knowledge, medication adherence and health-related quality of life (HRQoL) among hypertensive patients in Islamabad, Pakistan

Purpose: To determine knowledge regarding hypertension, adherence to medication and HealthRelated Quality of Life (HRQoL), and their associations in hypertensive patients in Pakistan. Methods: A cross-sectional study was conducted among 384 hypertensive patients attending a tertiary health care public sector hospital in Islamabad, Pakistan. Data were collected using knowledge questionnaire regarding hypertension, Morisky Medication Adherence Scale, and EuroQol (EQ-5D) scale. Results: The mean systolic and diastolic blood pressures of the 384 patients were 140.39 ± 15.485 and 88.74 ± 10.683 mmHg, respectively. The coefficient of correlation between knowledge regarding hypertension and adherence was 0.638 (p < 0.001), showing a positive association. The correlation coefficient between knowledge and HRQoL was 0.709 (p < 0.001), suggesting a good association. The correlation coefficient between adherence to medication and HRQoL was 0.545 (p < 0.001), which indicated a positive correlation. Conclusion: These results indicate that there are statistically significant associations between hypertension knowledge and HRQoL, hypertension knowledge and medication adherence, and between adherence and HRQoL in the hypertensive patients studied

CHILDREN QUITTING SOIL EATING HABIT AFTER HAVING A DIET CONSISTING OF MEAT AND CALCIUM

The objective of this study was to make children quit the habit of soil eating by administeringmeat, as a source of nutrients like proteins, vitamins and minerals along with oral calcium which can be given in the form of a chewable tablet. Data of 85 children of both genders was taken having a soil eating habit. On the basis of age children were divided into 3 groups, i.e. children of 2 to 6 years of age, childrenof 6 to 12 years of age and children above 12 years of age. Children were given one tablespoon of minced meat and a tablet of calcium daily for as long as the child takes to quit the soil eating This course of treatment was proven to be fairly effective. The reason forthis success was the fact that the cause behind soil eating is the body’s requirement forcertain nutrients (e.g.Anemicpeople have been reported to have such a habit, cause being iron deficiency) and soil or clay has all these nutrients, i.e. iron, calcium, zinc, proteins, vitamins etc. and so this need can also be fulfilled through a diet of meat and additional administration of calcium. Results showed that children of ages 2 to 6 years quit the soil eating habit the fastest in which males quit in 10 days while females in 12 days. Keywords: Soil eating habit, Oral Calcium, Vitamin and Protein

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

UKURAN FISIK ANAK NORMAL USIA 7-12 TAHUN (Studi Pendahuluan pada Siswa SDN Petompon 1 Semarang)

Backround:Both genetics and environmental factors could cause differences in child’s physical measurements. Thus, standard curves are needed to evaluate the presence of disorder or disturbance caused by those two factors. A huge number of samples are needed to make a reference curve. This research is aimed as a preliminary study to find the physical scales of normal children in Indonesia. Methods: This is a preliminary study with descriptive observasional design. The data were obtained by cross-sectional method between March-June 2011. Measurements were done on weight, standing height, sitting height, occipitofrontal circumference, armspan, inner canthal distance, outer canthal distance, interpupillary distance, ear length, chest circumference, internipple distance, and mid upper arm circumference, on 7 to 12 years old students of SD Petompon 1 Semarang. The data were then analyzed with Microsoft Excel, and presented in tables and graphs. The mean value of each measurement was plotted to corresponding reference curve. Result: The physical scales of 276 students, consisted of 128 boys and 146 girls, who met the inclusion criteria were obtained. It was showed that all physical measurement results on each age category were considered normal according to their corresponding reference/standard curve, except for sitting height and arm span. On some measurements, like weight, standing height, head circumference, interpupillary distance, internipple distance, and mid upper arm circumference, the means were tend to be lower compared to the means of their corresponding reference curve. Conclusion: Most of the physical scales of 7-12 years old children were considered normal according to their corresponding reference curve. However, their means were tend to be lower then the means of corresponding reference curve. A similar integrated study with larger scale is necessary to providestandard reference curves for Indonesian children

EFFECT OF LUBRICANTS ON THE STABILITY OF CLOPIDOGREL BISULPHATE TABLETS

The objective of the current study was to develop oral formulation of Clopidogrel Bisulphate 75mg tablet and perform the accelerated stability study to obtain the stable product by using the various lubricants like magnesium stearate, stearic acid and pregelatinized starch. Three different formulations of tablets were prepared and coded as F1, F2 and F3 containing the various lubricants i.e. magnesium stearate, stearic acid and combination of magnesium stearate and pregelatinized starch respectively. Tablets were prepared by direct compression method and the compressed tablets were film coated. The tablets were placed in a stability chamber and accelerated stability studies at 400C and 75% RH were carried out at time 0, 3 and 6 months duration. In accelerated stability study, various tests were performed including hardness, disintegration, chemical assay and in-vitro dissolution test. After preparation of tablets, the physical and chemical parameters of tablets at zero period of time were tested, and were found within their specification. After test the tablets were kept in the stability chamber for six months. After three and six months the physical and chemical parameters of tablets were also tested. According to the results, the formulations containing the magnesium stearate and stearic acid degraded with the passage of time but the formulation containing the combination of pre-gelatinized starch and magnesium stearate were more stable as compared to the formulations containing the lubricants as magnesium stearate and stearic acid. Key words: Clopidogrel Bisulphate, Pregelatinized starch, Accelerated stability studies, In-vitro dissolution

Factors influencing failure of bank protection Embankment of Surma River

This paper highlights the probable causes of failure of existing bank protection works of the River Surma for safety of Sylhet, the northeastern city of Bangladesh. In this study, eight places were selected where the concerned authority implemented bank protection works. Observation shows that the soil particle of the embankment carries significant amount of clay, fine silt and fine dust, indicating that the soil of such areas is subjected to be eroded, which poses a great risk to the safety of this city. Moreover, the grain size analysis of all the selected locations shows that the effective diameter (d10) of the soil sample is much lower than the value used in the design calculation of the authority. In consequence of this the scour depth would be more than the calculated one. However, the study will give a better understanding of those factors causing deterioration to the protective structures

Role of Natural Radiosensitizers and Cancer Cell Radioresistance: An Update

Cancer originates from genetic mutations accumulation. Cancer stem cells have been depicted as tumorigenic cells that can differentiate and self-renew. Cancer stem cells are thought to be resistant to conventional therapy like chemotherapy and radiation therapy. Radiation therapy and chemotherapy damage carcinomic DNA cells. Because of the ability of cancer stem cells to self-renew and reproduce malignant tumors, they are the subject of intensive research. In this review, CSCs radioresistant mechanisms which include DNA damage response and natural radiosensitizers have been summed up. Reactive oxygen species play an important role in different physiological processes. ROS scavenging is responsible for regulation of reactive oxygen species generation. A researcher has proved that microRNAs regulate tumor radiation resistance. Ionizing radiation does not kill the cancer cells; rather, IR just slows down the signs and symptoms. Ionizing radiation damages DNA directly/indirectly. IR is given mostly in combination with other chemo/radiotherapies. We briefly described here the behavior of cancer stem cells and radioresistance therapies in cancer treatment. To overcome radioresistance in treatment of cancer, strategies like fractionation modification, treatment in combination, inflammation modification, and overcoming hypoxic tumor have been practiced. Natural radiosensitizers, for example, curcumin, genistein, and quercetin, are more beneficial than synthetic compounds

Role of Natural Radiosensitizers and Cancer Cell Radioresistance: An Update

Cancer originates from genetic mutations accumulation. Cancer stem cells have been depicted as tumorigenic cells that can differentiate and self-renew. Cancer stem cells are thought to be resistant to conventional therapy like chemotherapy and radiation therapy. Radiation therapy and chemotherapy damage carcinomic DNA cells. Because of the ability of cancer stem cells to self-renew and reproduce malignant tumors, they are the subject of intensive research. In this review, CSCs radioresistant mechanisms which include DNA damage response and natural radiosensitizers have been summed up. Reactive oxygen species play an important role in different physiological processes. ROS scavenging is responsible for regulation of reactive oxygen species generation. A researcher has proved that microRNAs regulate tumor radiation resistance. Ionizing radiation does not kill the cancer cells; rather, IR just slows down the signs and symptoms. Ionizing radiation damages DNA directly/indirectly. IR is given mostly in combination with other chemo/radiotherapies. We briefly described here the behavior of cancer stem cells and radioresistance therapies in cancer treatment. To overcome radioresistance in treatment of cancer, strategies like fractionation modification, treatment in combination, inflammation modification, and overcoming hypoxic tumor have been practiced. Natural radiosensitizers, for example, curcumin, genistein, and quercetin, are more beneficial than synthetic compounds