Ethibond suture in uterus: an unusual cause for secondary sterility

Failure to conceive two years after the LSCS, the patient was being investigated. Hysteroscopy revealed the presence of Ethibond suture in the uterine cavity attached to the lower part of the previous LSCS scar. The presence of this foreign body was acting as an intra-uterine contraceptive device responsible for failure of contraception. The presence of foreign body in the uterus such as bone pieces left after previous abortion, presence of suture of cervical circlage etc. have been reported. But the presence of Ethibond suture in the uterine cavity resulting in secondary sterility is being reported for the first time

Hysteroscopy in evaluation of intrauterine causes of AUB

Background: Abnormal uterine bleeding is the most common gynecological problem comprising more than 30-50% of gynecological OPD patients. There are various causes of AUB from hormonal dysfunction to endometrial cancer. In order to manage effectively it is important to diagnose accurately the cause of abnormal bleeding. This study outlines the place of hysteroscopy and its role in evaluation of intrauterine causes of AUB.Methods: This is a Retrospective cross sectional observational study conducted in department of Obstetrics and Gynaecology at CCM Medical College, Durg, Chhattisgarh. 350 Patients between 20-70 years age presenting to general gynae OPD with abnormal uterine bleeding at CCM medical college over a period of 2 years between 1st January 2015 to December 2016 were studied. All patients were subjected to thorough clinical evaluation followed by sonography and hysteroscopy. Data collected from medical records, analysed and various intrauterine causes of AUB were studied.Results: Mean age of patients in our study was 45 years with majority of patients in 40-50 year age group. predominant complaint reported was menorrhagia (52%) followed by menometrorrhagia (18.86%) and polymenorrhoea (18.58%). USG detected abnormality in 65.6 % of cases and 34.4% were normal on USG but majority of these were fibroids and ovarian cysts. However, diagnosis of specific intrauterine pathology was made in only 12.8%. Hysteroscopy detected intrauterine abnormality in 60% cases. Most common being polyp in 94 patients (26.8%) followed by hyperplastic endometrium in 74 (21.1%). 18 (5.1%) patients had polypoidal endometrium which is also type of hyperplastic endometrium. 17 (4.85%) had submucous fibroid, 4 (1.1%) had atrophic lining and 3 (0 .85%) had intrauterine adhesions. Diagnostic accuracy of hysteroscopy was found better in polyps and submucous myomas which were missed by usg and also can be missed by traditional D and C only.Conclusions: Hysteroscopy allows exclusion of intracavitary pathology as well as treatment of them in same sitting with proper tissue biopsy from the abnormal area which can be of help in proper treatment planning. Though hysteroscopy helps in diagnosing cause of AUB their proper management will depend on final histology, age of patient and fertility goals

Epidemiological study of congenital malformations at birth in a tertiary health centre in central India

Background: The proposed study was carried out to determine incidence of congenital malformations, incidence of CM in live and still births, risk factors attributable, maternal and perinatal outcome, to frame the recommendations for early detection and prevention of CM.Methods: Prospective observational study. The cases selected from those attending the antenatal O.P.D. and those admitted in wards of Obs and Gynae Dept., GMH who delivered congenitally malformed baby dated from August 2013-July 2014. A detailed history, examination, relevant investigations was done.Results: Out of 9014 deliveries, 110 babies had CM. The incidence of CMs was found to be 1.22%. Maximum number (24.55%) of CM s were of CNS, most common was NTD (Anencephaly). Incidence of CMs was more in still births, mothers of age >40 yrs and <20 yrs, of illiterate, educated <8 std., house wives, rural areas, unbooked and multigravida. Most CM fetuses were delivered prematurely (67.27%). CVS and CNS systems were more commonly involved in consanguinous married couples. CM was associated with drug intake, 1.82% on antiepileptics, 1.82% on antihypertensives, 3.64% on oral hypoglycaemics,0.91% on NSAID,6.36% on unspecified drugs. 12.73% CMs were seen in passive smokers, 6.36% consumed alcohol, 17.27% pan/gutka intake. Majority were delivered by vaginal route, maximum fetuses (82.73%) were in vertex presentation, maximum (67.27%) CMs were in male babies.Conclusions: Many malformations arise because of the interplay of genetic, environmental and multifactorial factors. The stress imposed may be reduced considerably by understanding the causes of the malformations and adopting the management strategies outlined for the prevention or reduction of CM

Laparoscopic management of adnexal masses in admitted patients at tertiary care centre, Bhilai, Chhattisgarh, India

Background: Laparoscopy is most widely accepted procedure in gynaecological cases both for diagnostic and operative purposes. It is associated with early recovery, shorter hospital stay and significant patient satisfaction. This study has been conducted to evaluate the effectiveness and safety of laparoscopy in the management of adnexal masses. Our Primary aim was to find out indications, intraoperative findings and different interventions to deal with adnexal mass. The objective of the study was to determine laparoscopic management of adnexal mass in all women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai, Chhattisgarh.Methods: This is a retrospective record-based observational study conducted over a period of one year from March 2020 to March 2021 after getting approval from the institutional ethical committee. Patients diagnosed with adnexal mass were evaluated and data was collected and analyzed.Results: Of the 130 cases of adnexal mass admitted in the hospital during the period under review, 43 cases (33%) were diagnosed as ovarian cyst among which simple cystic ovarian cyst was found to be most common etiology followed by ectopic pregnancy (41 cases). Majority of cases were managed laparoscopically with a good success rate, better outcome and short hospital stay. Conversion rate to laparotomy was 3.8% mainly seen in cases with complex ovarian mass or dense adhesions.Conclusions: Diagnosis of adnexal mass is important and it may affect females of any age group. Laparoscopy is a better approach to deal with adnexal masses (except malignancy) as it has better paronamic vision with less complications, less post-operative pain, shorter hospital stay. Careful patient selection should also be taken into account. Current study is an overview in favor of laparoscopic management of adnexal mass

Growing Quality Green Jobs: Driving Economic Advancement in the Green Economy

The Green Transformation Cycle, a new data-driven framework developed as a part of the CREST Initiative by Jobs for the Future (JFF), in partnership with the Burning Glass Institute (BGI), with support from Ares Charitable Foundation, advances our nation's progress to a green economy by prioritizing environmental sustainability as well as equitable economic advancement.  Our approach—including an analysis of nearly 200?million online job postings—demonstrates that when the integration of current green skills into various occupations is considered, green jobs are more prevalent than commonly thought. This report leverages the Green Transformation Cycle to illustrate the economic transformation currently underway, and to better shape workforce training programs, employer talent pipelines, and emerging legislation to support the urgency of a just transition to a green economy.

Fatal Dog Bite Injury – A Case Report

Background: Dog bite is one of the most common childhood accidents causing significant morbidity and mortality in pediatrics age group (1). The exposed position compounded by the short stature of children makes the face very vulnerable to dog bite or animal bite injuries. Unlike wounds inflicted by assaults and accidents, animal bite wounds are distinctive as they are puncture type deep wounds which are injected by the bite force, with inoculums of pathogenic bacteria from the saliva of the attacking dog.Case Report: A case of a 2 month-old child who had succumbed to multiple facial and head bite injuries is presented. At autopsy, multiple bite wounds were noted on the upper part of body like face, head, chest and abdomen. Distinctive bite marks diagnostic of canine dentition were present, most prominently on the head, face and chest. Death was due to cranio-cerebral damage.Conclusion: Public health notification should occur for all dog bites. This would facilitate the development of regional dog bite registries with information on incidence and dogs at risk, which in turn could guide policies such as leash laws and licensing

In vitro screening of white Jute (Corchorus capsularis L) against salinity stress

The environmental stress such as salinity of soil or water is serious threat for field crops in the world, especially in arid and semiarid regions. To study salinity stress on jute (Corchorus capsularis), an experiment was laid out in factorial randomized block design keeping nine capsularis varieties (JRC-698, JRC-321, JRC-517, JRC-7447, JBC-5, JRC-212, JRC-80, JRC-532 and UPC-94) as one factor and four levels of salt concentrations i.e. control (Distilled H2O), 100, 160, 240 and 300 mM NaCl with three replications. Adverse effect of salinity increased with increasing concentration of sodium chloride. Among nine jute varieties the highest germination percentage (89.5%), root length (0.6 cm), shoot length (1.2 cm), fresh weight (93 mg) and dry weight (9.5 mg) of seedling were observed in ‘JRC-698’ at salt concentration at 160 mM NaCl as compared with other salt concentration. All growth parameters were recorded higher in control than other treatments. All growth parameters were decreased up to 240 mM NaCl concentration and it was completely inhibited at 300 mM NaCl. Variety ‘UPC-94’ was the most susceptible to salinity stress. Hence, white jute varieties, JRC-698 and JRC-517 can be grown at 160 mM NaCl concentration

Prevalence and architecture of de novo mutations in developmental disorders.

The genomes of individuals with severe, undiagnosed developmental disorders are enriched in damaging de novo mutations (DNMs) in developmentally important genes. Here we have sequenced the exomes of 4,293 families containing individuals with developmental disorders, and meta-analysed these data with data from another 3,287 individuals with similar disorders. We show that the most important factors influencing the diagnostic yield of DNMs are the sex of the affected individual, the relatedness of their parents, whether close relatives are affected and the parental ages. We identified 94 genes enriched in damaging DNMs, including 14 that previously lacked compelling evidence of involvement in developmental disorders. We have also characterized the phenotypic diversity among these disorders. We estimate that 42% of our cohort carry pathogenic DNMs in coding sequences; approximately half of these DNMs disrupt gene function and the remainder result in altered protein function. We estimate that developmental disorders caused by DNMs have an average prevalence of 1 in 213 to 1 in 448 births, depending on parental age. Given current global demographics, this equates to almost 400,000 children born per year

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)