Maternal and perinatal outcomes in critically ill obstetric patients

Background: The present study was done to analyze the outcome of critically ill antenatal and postnatal women in the intensive care unit (ICU) of a tertiary care teaching hospital. The study was done to identify and analyze the risk factors that influence maternal-perinatal morbidity and mortality.Methods: All the obstetric patients admitted to ICU during January 2009 to December 2013 were analyzed retrospectively. The indications for transfer to ICU, obstetric and non-obstetric causes were evaluated. Mortality Probability Model (MPM2) score was calculated and risk of mortality estimated. The course and complications during hospital stay were noted.Results: 57 obstetric patients were admitted during the above mentioned period representing 5/1000 deliveries. Postpartum patients outnumbered antenatal women (31 vs. 26). Obstetric causes- preeclampsia, hemorrhage and sepsis were common indications for admissions. Respiratory failure and the need for mechanical ventilation was the most common reason for critical care. Maternal mortality was 28% and the perinatal mortality was 50%.Conclusions: Pregnancy-induced hypertensive disorders and hemorrhage were the major risk factors apart from pneumonia and hepatitis that continue to take toll in obstetric patients. Adequate antenatal care, increased vigilance of women during pregnancy for subtle signs and symptoms, early transfer to tertiary centre and aggressive management to prevent complications can bring about the desired reduction in maternal-perinatal morbidity and mortality

Analysis of various types of ectopic pregnancies: a five-year review

Background: Ectopic pregnancy (EP) is a common, life threatening emergency during the first trimester and a significant cause for maternal morbidity and mortality. In any woman of reproductive age presenting with abdominal pain and vaginal bleeding, ectopic pregnancy should be considered. The objectives of the present study is to determine the incidence, risk factors, clinical presentation, type of ectopic pregnancy, treatment, morbidity and mortality.Methods: Retrospective analysis of case sheets of patients admitted with ectopic pregnancy at PSGIMSR, Coimbatore during the period July 2011 to June 2016 was done. The details noted were age, parity, risk factors {previous abortion, previous EP, previous pelvic surgery, intrauterine contraceptive device, tubectomy, history of pelvic inflammatory disease}, treatment for infertility, clinical presentation, ultrasound findings, investigations including beta HCG value and hemoglobin level, treatment offered, need for blood transfusion, operative findings and morbidity.Results: During the five year, there were 12,407 deliveries at our hospitals and 88 cases of ectopic pregnancies were managed. The incidence is 6.6/1000 deliveries. Among them 44% belonged to the age group of 25-30 years and multi gravida were 73.8%. Most common risk factors were previous abortion (23.8%) and previous surgeries including caesarean section, tubectomy, appendicectomy, tubal microsurgery (23.8%). Most common presentation was pain abdomen (85.2%). Out of the 88 cases, 73 patients were managed surgically (82.9%) and 11 cases were managed successfully with methotrexate (12.5%). Three of them underwent conservative management and one had Uterine Artery Embolization.Conclusions: Early diagnosis based on risk factors and timely intervention plays a main role in reducing morbidity and mortality associated with ectopic pregnancy

Pyrolysis Caused Tail-Off Thrust in a Solid Rocket Motor: A Semi-Empirical Model

Knowledge of tail-off thrust characteristics of solid rocket motors used for an upper stage of satellite launch 'Vehicle is essential for proper sequencing of stage separation. The phenomenon is highly complex and theoretical models accurately describing the tail-off thrust are not available. Only rough estimates can be made through ground testing. A semi-empirical model is derived by the authorsusing the Indian polar satellite launch vehicle (PSL V) flight data and is used for fixing the time of stage separation. The model has been validated using data over an extended duration from another flight ofthe PSL V. The method adopted for modelling is described

Towards Non-contact 3D Ultrasound for Wrist Imaging

Objective: The objective of this work is an attempt towards non-contact freehand 3D ultrasound imaging with minimal complexity added to the existing point of care ultrasound (POCUS) systems. Methods: This study proposes a novel approach of using a mechanical track for non-contact ultrasound (US) scanning. The approach thus restricts the probe motion to a linear plane, to simplify the acquisition and 3D reconstruction process. A pipeline for US 3D volume reconstruction employing an US research platform and a GPU-based edge device is developed. Results: The efficacy of the proposed approach is demonstrated through ex-vivo and in-vivo experiments. Conclusion: The proposed approach with the adjustable field of view capability, non-contact design, and low cost of deployment without significantly altering the existing setup would open doors for up gradation of traditional systems to a wide range of 3D US imaging applications. Significance: Ultrasound (US) imaging is a popular clinical imaging modality for the point-of-care bedside imaging, particularly of the wrist/knee in the pediatric population due to its non-invasive and radiation free nature. However, the limited views of tissue structures obtained with 2D US in such scenarios make the diagnosis challenging. To overcome this, 3D US imaging which uses 2D US images and their orientation/position to reconstruct 3D volumes was developed. The accurate position estimation of the US probe at low cost has always stood as a challenging task in 3D reconstruction. Additionally, US imaging involves contact, which causes difficulty to pediatric subjects while monitoring live fractures or open wounds. Towards overcoming these challenges, a novel framework is attempted in this work.Comment: 9 Pages, 11 figure

Performance analysis of Woods Hole taut moorings

The Woods Hole Oceanographic Institution has been using deepsea moored buoys for acquiring serial observations of ocean currents, temperature .and other data for over twelve years. A brief description of the deep-sea mooring program is given. The mooring statistics and performance are described. Mooring failures of 1970 and 1971 have been categorized and statistics on the modes and causes of failures are presented. The reliabilities of different types of moorings are computed and compared. The role of radio telemetry for the real-time measurement of mooring line tension and its use in checking the mooring status are discussed. Examples of potential design data like tension and currents recorded by moorings that failed are provided. Finally, recommendations for research and development needed to improve mooring reliability are given.Prepared for the Office of NavaZ Research under Contract N00014-66-C024lj NR 083-004

A Simplified 3D Ultrasound Freehand Imaging Framework Using 1D Linear Probe and Low-Cost Mechanical Track

Ultrasound imaging is the most popular medical imaging modality for point-of-care bedside imaging. However, 2D ultrasound imaging provides only limited views of the organ of interest, making diagnosis challenging. To overcome this, 3D ultrasound imaging was developed, which uses 2D ultrasound images and their orientation/position to reconstruct 3D volumes. The accurate position estimation of the ultrasound probe at low cost has always stood as a challenging task in 3D reconstruction. In this study, we propose a novel approach of using a mechanical track for ultrasound scanning, which restricts the probe motion to a linear plane, simplifying the acquisition and hence the reconstruction process. We also present an end-to-end pipeline for 3D ultrasound volume reconstruction and demonstrate its efficacy with an in-vitro tube phantom study and an ex-vivo bone experiment. The comparison between a sensorless freehand and the proposed mechanical track based acquisition is available online (shorturl.at/jqvX0).Comment: 4 pages, 4 figure

The prevention and management of hospital admissions for urinary tract infection in patients with multiple sclerosis

Introduction Urinary tract infections (UTIs) are one of the commonest reasons for patients with multiple sclerosis (PwMS) presenting to hospital. Management of recurrent UTIs in PwMS can be challenging and characteristics of such patients are not well described. Aims To describe the neurological and urological features of PwMS presenting to hospital for UTIs and identify areas of management that could be improved to reduce UTI frequency. Methods Health episode statistics data were used to identify PwMS presenting to a tertiary hospital with UTI over a 5-year period. Medical records were reviewed for demographic, MS and urological history. The seven PwMS with the highest numbers of encounters were seen in a multidisciplinary clinic to enable detailed assessments. Results 52 PwMS (25 female, 27 male) with mean age of 60 had 112 emergency department presentations and 102 inpatient admissions for UTI. 24 presented multiple times and were more likely to be older and male with progressive MS. Almost two-thirds were using a urinary catheter. Less than half were under current urological and neurological follow-up. Escherichia coli and Pseudomonas spp were the commonest organisms cultured. Resistance to antibiotics was more frequent in patients with multiple presentations. Conclusions PwMS presenting to hospital for UTIs are more often male, older, with progressive MS and high levels of disability. A small group of PwMS accounted for a large number of encounters. Preventative and management strategies can be applied in primary and secondary care settings, with an emphasis on bladder, catheter and general physical care

Delivery of urethral sphincter botulinum toxin injections for treating urinary retention during the COVID19 pandemic

Aims: Urethral sphincter botulinum toxin injections is an alternative treatment for urinary retention in women with Fowler’s syndrome and when access to health services were curtailed during the Covid19 pandemic, we continued to offer treatment to prevent increased demand on catheter services due to a recurrence of urinary retention. We describe our experience delivering safe and timely treatment during this period of lockdowns and restricted access to healthcare. // Methods: We retrospectively reviewed the records of all women with Fowler’s syndrome treated with transperineal urethral sphincter botulinum toxin injection between 23rd March 2020 and 31st December 2021 in a tertiary university hospital and clinical outcomes were recorded. // Results: 15 women (mean age 35.6 ± 10.1 years) received 100U OnabotulinumtoxinA injected into the external urethral sphincter as an out-patient procedure adopting hospital infection control guidelines. 41 injections were administered in total, and 8 (53%) patients received more than 1 injection (median 2 injections/patient, median inter-injection interval 108.5 days). 10 (66.7%) patients reported improvements in urinary symptoms across 31/41 (75.6%) of injections. Side effects were reported after 21.4% of injections which were mild and transient. No patients developed Covid19 within 4 weeks of the hospital visit. // Conclusion: Real-world data shows that transperineal urethral sphincter botulinum toxin injections could be continued safely and effectively during the Covid19 pandemic. This essential outpatient service played an important role in treatment and quality of life for women with Fowler’s syndrome, and avoided an additional burden on the NHS at the time of a health crisis

Treatment Options for Urogenital Dysfunction in Parkinson's Disease

OPINION STATEMENT: Urogenital dysfunction is commonly reported in Parkinson's disease (PD), and history taking and a bladder diary form the cornerstone of evaluation. The assessment of lower urinary tract (LUT) symptoms include urinalysis, ultrasonography, and urodynamic studies and help to evaluate concomitant urological pathologies such as benign prostate enlargement. Antimuscarinic medications are the first line treatment for overactive bladder (OAB) symptoms and solifenacin has been specifically studied in PD. Antimuscarininc drugs may exacerbate PD-related constipation and xerostomia, and caution is advised when using these medications in individuals where cognitive impairment is suspected. Desmopressin is effective for the management of nocturnal polyuria which has been reported to be common in PD. Intradetrusor injections of botulinum toxin have been shown to be effective for detrusor overactivity, however, are associated with the risk of urinary retention. Neuromodulation is a promising, minimally invasive treatment for PD-related OAB symptoms. Erectile dysfunction is commonly reported and first line treatments include phosphodiesterase-5 inhibitors. A patient-tailored approach is required for the optimal management of urogenital dysfunction in PD