An alarming but self-limited case of isolatedlarge spontaneous liver hematoma in pregnancy

Spontaneous subcapsular liver hematoma is rare but potentially life-threatening complication of pregnancy usually associated with severe preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). We present here a case of such a large spontaneous liver hematoma presenting in pregnancy, but without other known associated abnormalities, which has not been described before and it resolved on itself without any intervention.Pan African Medical Journal 2013; 14:3

Butorphanol in Labour Analgesia

Introduction: Labour is the process where uterine contractions lead to expulsion of product of conception through the vagina into the outer world. Labour pain is one of the most severe pains which has ever been evaluated and its fear is one of the reasons women wouldn’t go for natural delivery. Delivery is a painful experience for all of the women except a few of them. The labor pain results from some physiological-psychological causes. Different pharmacological and non-pharmacological methods have been tried for pain relief in labour. The objective of this study is to see the effect of butorphanol injection in labour pain. Methods: It is a descriptive cross-sectional study conducted in B.P. Koirala institute of health sciences. We observed 200 pregnant women meeting the inclusion criteria and giving the informed consent who were on 1 mg butorphanol i.m. at the onset of active stage of labour every 4 hourly and on demand. Pain assessment was done by Numerical Pain analogue scale measured from 1 to 10. Fetal heart rate monitoring was done according to the hospital protocol. Caesarean section was performed for obstetrical indication. Neonatal outcome was evaluated by on duty pediatrician and APGAR score were noted at 1 and 5 min. Results: The pain scores in first, second, third, fourth hour were (8.83±0.773), (9.84±0.544), (9.94±0.338), (9.6±0.298) respectively, where 1st and 2nd hour is statistically significant. Conclusions: Butorphanol is an effective labour analgesia without significant adverse effects on women and the neonatal outcome

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

Gartner’s Duct Cyst of the Vagina: A Case Report

Paramesonephric duct or Mullerian ducts forms female genital organs whereas mesonephric ductforms male genital organs. The remnant of the mesonephric duct or Wolffian duct in femalessometimes forms a mesonephric cyst or Gartner’s duct cyst. They are usually asymptomatic and &lt;2cm but sometimes can be bigger. It is diagnosed with pelvic examination. It is treated with surgicalexcision of the cyst. This is a unique case in urogynecology as it confuses with pelvic organ prolapseand the mode of treatment is completely different. We report a case of 32-years old lady whopresented in urogynecology outpatient department with complain of pelvic organ prolapse. Afterexamination she was diagnosed as vaginal cyst and excision was done and confirmed as Gartnerscyst in histopathological examination.</jats:p

Imperforate Hymen: A Rare Cause of Abdominopelvic Mass in an Infant

Symptomatic imperforate hymen is very rare in infants. Here we report a neonate who presented with imperforate hymen with abdominal distension, fever and loose stool. Imaging study showed large thick walled cystic lesion extending from pelvis to abdomen upto epigastric region with bilateral mild hydroureteronephrosis and lower part in between urinary bladder and rectum suggesting hydrometrocolpos. There was spontaneous rupture leading to flow of collection. It leads to spontaneous resolution of the mass which was confirmed with pelvic ultrasound and computed tomography.Keywords: Hydrometrocolpos; hydroureteronephrosis; imperforate hymen</jats:p

High resolution light-sheet based high-throughput imaging cytometry system enables visualization of intra-cellular organelles

Visualization of intracellular organelles is achieved using a newly developed high throughput imaging cytometry system. This system interrogates the microfluidic channel using a sheet of light rather than the existing point-based scanning techniques. The advantages of the developed system are many, including, single-shot scanning of specimens flowing through the microfluidic channel at flow rate ranging from micro- to nano- lit./min. Moreover, this opens-up in-vivo imaging of sub-cellular structures and simultaneous cell counting in an imaging cytometry system. We recorded a maximum count of 2400 cells/min at a flow-rate of 700 nl/min, and simultaneous visualization of fluorescently-labeled mitochondrial network in HeLa cells during flow. The developed imaging cytometry system may find immediate application in biotechnology, fluorescence microscopy and nano-medicine

An experience of gynaecological laparoscopic surgeries at low resource setting.

Introduction: Evolution of laparoscopy has revolutionised the field of gynaecological surgery for more than 40 years.Owing to the long learning curve, added expenses and lack of awareness among patients and surgeons, its introduction and development in Nepal is not upto the timeline. Gynaecologic laparoscopy (GL) seems to be introduced at BP Koirala institute of Health Sciences, Dharan,Nepal (BPKIHS) since 2002. It remained in latency because of widespread lack of equipment and skilled personnel. Some laparoscopic procedures like diagnostic laparoscopy, laparoscopic tubal ligation and very few laparoscopic assisted vaginal hysterectomy (LAVH) were done from 2002 - 2012 (10 years). Since then more gynecologists  have been trained in GL which has contributed to expansion of GL.&#x0D; Objective: The objective of this study is to study and share trends of gynaecological laparoscopic surgeries performed at BPKIHS.&#x0D; Methodology: All the patients undergoing GL surgeries have been analyzed for the indication, type of procedure, conversion and its complications.  We took data from operation theatre register and patient case sheet from July 2004 to May 2018. We divided this period into two phase viz Phase 1: July 2004-June 2013 and Phase 2: July 2013- till May 2018.&#x0D; Results: Total number of GL done in this period was 427. Out of which 102 cases were from phase one and rest of the cases were done in five years of phase II. Number of operative laparoscopy has increased in phase 2 compared to phase 1. In last five years there was155 (47.6%) cases of adnexal surgery, 77 (23.6%) cases of diagnostic laparoscopy.Total laparoscopic hysterectomy was done in 25 (7.6%) cases. Conversion to laparotomy was done in4.6% (n=15) cases. Overall 12(3.7%) patient had major complications. Oral diet started at 4-6th hour post-operatively, and mobilization started after 24 hours. Seventy percent of patient had a hospital stay of 2days and rest stayed for 3 days.&#x0D; Conclusions: There is rising trend in operative GL at BPKIHS.  We are facing less complication with expanding experience. There has been good learning from each case. GL has well demonstrated its advantages of reducing postoperative pain and morbidity, short hospital stay, and less postoperative recovery time. We have plans to get new gadgets and expand services in GL.</jats:p

Pre-hospital care, pre-hospital delay, and in-hospital delay in patients with traumatic brain injury in getting neurosurgical care in a tertiary care center: A Cross-Sectional study.

Introduction: Timely institution of pre-hospital therapies aimed at damage control and the appropriately timed decision of transfer to higher centers for definitive neurosurgical management are crucial in determining the outcome of patients following traumatic brain injury. This study aimed to evaluate the factors determining pre-hospital care and delay in patients with traumatic brain injury. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center after obtaining ethical approval from the Institutional Review Board (approval number 392 (6-11) E2). All patients with traumatic brain injury who presented to the emergency department from 1 July, 2018 to 15 June, 2019 were enrolled. Data related to patient demographics, the primary cause of the incident, grading of traumatic brain injury on admission, pre-hospital care, and variables that cause pre-hospital delay were collected. Results: In this study of 144 patients with traumatic brain injury, we found that 70 (48.61%) experienced transfer delays exceeding one hour. There were 71 (49.31%) patients aged 15-44 years, and 100 (69.44%) were males , with falls being the primary cause of 119 (82.64%). Most patients had mild traumatic brain injury 80 (55.56%). Out of 144, 20 (13.89%) received prehospital care, and 28 (19.44%) underwent a computed tomography scan of the head before arrival. Conclusions: Our study highlights the challenges in pre-hospital care and delays in reaching for neurosurgical care in patients with traumatic brain injury. Falls, road accidents, and physical assaults were the leading causes

Explaining the Factors Affecting Customer Satisfaction at the Fintech Firm F1 Soft by Using PCA and XAI

The most significant and rapidly expanding fintech services in Nepal are provided by several fintech firms. Customer satisfaction must be compared side by side even if every organization has made an effort to expand the usage of services. Many studies have concentrated on evaluating the impact of various factors on customer satisfaction, but significantly fewer studies have been conducted to explore the factors and focus of machine learning. Based on the planned behavioural theory (TPB), the study is concentrated on exploring and evaluating customer satisfaction on a different stimulus offered by F1 Soft (a fintech firm in nepal), customers&rsquo; loyalty and the compatibility they gain through the company&rsquo;s services. By exploring various factors affecting customer satisfaction by using principal component analysis (PCA) and explainable AI (XAI), the study explored the eight factors (customer service, compatibility, ease of use, assurance, loyalty intention, technology perception, speed and firm&rsquo;s innovativeness) which affect customer satisfaction individually. Furthermore, by using support vector machine (SVM) and logistic regression (LR), the major contributing factors are explained with local interpretable model-agnostic explanation (LIME) and Shapley additive explanations (SHAP). SVM holds the training accuracy of 89.13% whereas LR achieves 87.88%, and both algorithms show that compatibilty issues consider the major contributing factor for customer satisfaction. Contributing toward different dimensions, determinants, and the results of customer satisfaction in fintech, the study suggests how fintech companies must integrate factors affecting customer satisfaction in their system for further process development