Prospective study of large uterine fibroids encountered during laparotomy and hysterectomy and their management

Background: Study of large fibroids is necessary to throw light on complications associated with them. This helps the surgeon to safeguard patients from anticipated complications during surgery. The objective is to study the clinical features, complications and outcome of large uterine fibroids.Methods: A hospital based prospective study was carried out among 32 eligible patients undergoing laparotomy hysterectomy at Department of Obstetrics and Gynecology from October 2015 to June 2018. Age groups, clinical features, complications and outcome of surgery were recorded. Data was analyzed using proportions.Results: Majority of the study subjects were in the age group of 25-35 years. The most common presenting symptom of large size fibroid uterus was abnormal uterine bleeding followed by pain abdomen in 18.8% of the cases. Majority of the women had fibroid size of 16-20 weeks in 62.5% of the cases followed by size of the 20-26 weeks in 31.3% of the cases. Only two women had very large size of 26-28 weeks in 6.3% of the cases. Only three patients had intra operative complications (9.4%). Among them two (6.3%) had injury to the urinary bladder and only one had injury to the ureters. 90.6% of the cases had no intra operative complications. All cases had complete symptomatic relief. Thus the successful outcome was seen in 100% of the cases.Conclusions: Large uterine fibroids can end up with urological complications more than smaller fibroids. Among these bladder and ureteric complications are important. Malignant degeneration is rare. Other complications include infection and wound dehiscence

A study to assess factors contributing for the occurrence of incisional hernia among patients operated with pfannenstiel incision and management with mesh repair

Background: Incisional hernia is due to failure of lines of closure of abdominal wall following laparotomy. Bowel or a part of bowel or omentum can bulge through the gap. The early occurrence (within 5 years) is mainly due to early sepsis and obesity. Objective of present study was to assess the factors contributing for the occurrence of incisional hernia.Methods: All the women who were operated between March 2014-December 2016 using a low transverse Pfannenstiel incision and who did not have any other lower (vertical) incisions and laparoscopic surgeries were followed up in the outpatient department. 1,252 cases were followed up during the above-mentioned period and the detail history was elicited and meticulous physical examination was conducted. USG Abdomen was done in all the cases. Out of 1,252 cases 25 were having incisional hernia and mesh repair was done for incisional hernia.Results: Nearly 2% of these cases had incisional hernia. Obesity was the main risk factor in 36% of the study participants followed by wound infection in 32%.Conclusions: Obesity, redo surgeries, size of the incision and type of suture materials used contribute to the formation of incisional hernia. Although the incidence is low still incisional hernia can occur following Pfannenstiel low transverse abdominal incision

A prospective study of abdominal wall endometriomas: a review of 16 cases

Background: Endometriosis is a disorder in which an ectopic endometrial tissue grows outside the uterine cavity. The ectopic endometrium in abdominal wall is called as abdominal wall endometriosis (AWE). AWE is a very rare condition and exact incidence is not known. This is usually known to develop along with previous surgical scars especially following Caesarean section and Hysterectomy.Methods: Retrospective analysis of the patients operated for AWE was done. Data relating to age, symptomology, and previous caesarean section, relation to symptoms with the menstrual cycle, physical examination, surgical treatment and post-operative course was analyzed.Results: 16 patients were operated during the study period of 3 years between September 2013-september 2016.The ages ranged between 20-35 years. Presences of local mass and cyclical pain during menstruation were the main symptoms. Ultrasonography was done in all the cases and CT abdomen was done in few cases (2) to know the exact depth of the mass and to differentiate from other diseases. Wide surgical excision was carried out in all cases.Conclusions: There is definite relationship with AWE and caesarean sections in women

A clinical study of large ovarian cyst with various presentations: prospective interventional study

Background: The definition of huge ovarian cysts is not well described in the literature. Some authors define large ovarian cysts as those that are more than 10 cm in diameter as measured by preoperative scans. An ovarian cyst is a common gynecological problem and is divided into two main categories; physiological and pathological. Aims and objectives of this study was to find out various presentations of large ovarian tumour.Methods: It was a prospective interventional study done for a period of two year from March 2015 to March 2017 in Department of Obstetrics and Gynecology as well as in Department of General Surgery. During the study period a total of 30 study participants were enrolled.Results: Majority of the study participants were in the age group of 18-28 years (66.66%) and 33.33% were in the age group of 28-38 years. Near about 33.33% were uncomplicated. Near about 33.33% presented with tortion, 7% with rupture of cyst, infection was seen in 13.33%. About 13.33% were malignant cyst.Conclusions: Large ovarian cysts are a clinical challenge for Gynaecologists. Quite a good number of these cases can end up with complications and hence, all of them have to be subjected to surgery

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Frames Of Reference And Students’ Conceptual Understanding Of Seasons

This thesis focused on students’ misconceptions in the topic of seasons. Its three investigations, explored the central question of: How do frames of reference influence students’ conceptual understanding of seasons? The results from these investigations found that some single frames of reference can limit students’ understanding of seasons or confuse students, while additional frames of reference can enhance students’ understanding. These three investigations were driven by the principles of design research methodology. They examined how frames of reference provided by: Starry NightTM software, 3D models and textbook diagrams influenced students’ understanding of seasons. The first investigation compared two groups of students. One group, the Egocentric Group (n=15), used Starry NightTM. The second group, the Exocentric Group (n=13), mainly used text diagrams and 3D models. This investigation isolated different frames of reference in students’ explanations of seasons. The results from this first investigation revealed that different frames of reference limit students’ explanations of seasons. The second investigation addressed findings from the first investigation and observed how sixteen, grade six students’ explanations about seasons changed as they were exposed to different frames of reference over the course of seven days for two hours per day. Students gave written explanations to the same questions about seasons during the first, fourth and seventh days. The results in this investigation revealed that students’ explanations of seasons changed gradually and incorporated their experiences as they were introduced to new frames of reference. The third investigation explored what was happening to the students’ intuitive understanding of seasons as they moved between different frames of reference in a problem-solving situation. Qualitative discourse analysis from three pairs of students found that as students moved between different frames o f reference they brought different types of knowledge to bear on their initial ideas about seasons. This thesis concluded that using a variety of frames of reference to teach students about seasons helps them relate to the topic in multiple ways. This method fosters better understanding of seasons and prepares students to explore other topics in astronomy

Foliar application of Zn at flowering stage improves plant’s performance, yield and yield attributes of black gram

548-555Black gram plants subjected to varying levels of Zn supply (0.01 to 10 µM Zn) showed optimum growth and dry matter yield in plants receiving 1 µM Zn. The dry matter yield of plants decreased in plants receiving 0.01 and 0.1 µM Zn (deficient) and excess levels of Zn (2 and 10 µM Zn). The plants grown with Zn deficient supply showed delayed flowering, premature bud abscission, reduced size of anthers, pollen producing capacity, pollen viability and stigma receptivity resulting in poor pod formation and seed yield. Providing Zn as a foliar spray at pre-flowering stage minimized the severity of Zn deficiency on reproductive structure development and enhanced the seed nutritional status by enhancing seed Zn density, seed carbohydrate (sugar and starch content) and storage proteins (albumins, globulins, glutenins, and prolamines)