An institutional study of cesarean delivery on maternal request

Background: Cesarean delivery on maternal request refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of a standard medical/obstetrical indication for avoiding vaginal birth. The aim of the study was to find out the reasons behind, and the incidence of women preferring Cesarean section in the absence of obstetric and medical indications.Methods: This was a prospective study among women who came for delivery at Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, over a period of one year from 1st April 2015 to 31st March 2016. All women who underwent Cesarean delivery for maternal request were included in this study.Results: The total number of deliveries during the study period of one year was 2574. There were 1346 (52.29%) vaginal deliveries and 1228 (47.7%) cesarean deliveries. Among 1228 Cesarean deliveries, 87 (7.08%) had maternal request as their indication. Majority of them were in the age group of more than 35 years. Multigravidae opted for Cesarean delivery more than primigravidae (59 multigravidae vs 28 primigravidae). Among the various reasons for women requesting delivery cesarean were tocophobia, refusal of trial of labor after Cesarean section (TOLAC), concurrent sterilization, prolonged infertility and treatment conception, afraid of neonatal outcome (previous adverse neonatal outcome) and astrological concerns.Conclusions: Many of the women opted for Cesarean delivery in our study for preventable reasons like painless labor and concurrent sterilization which would have been easily avoided by prior counseling starting from antenatal period and by providing labor analgesia. Patient education and personal involvement of the treating obstetrician in counseling the patient and emotional support during labor can reduce Cesarean delivery for maternal request

AN INNOVATIVE METHOD DEVELOPMENT AND FORCED DEGRADATION STUDIES FOR SIMULTANEOUS ESTIMATION OF SOFOSBUVIR AND LEDIPASVIR BY RP HPLC

Objective: To develop an innovative, rapid, simple, cost-effective, stability indicating reverse phase-high performance liquid chromatography (RP-HPLC) method for simultaneous estimation of ledipasvir (LP) and sofosbuvir (SB) in combination pill dosage form. Methods: The method was developed using C8 column, 250 mm x 4.6 mm, 5 mm using mobile section comprising of 0.1% (v/v) orthophosphoric acid buffer at pH 2.2 and acetonitrile in the ratio of 45:55 that was pumped through the column at a flow rate of 0.8 ml/min. Temperature was maintained at 30 °C, the effluents were monitored at 260 nm with the help of usage of PDA detector. Results: The retention time of LP and SB were found to be 2.246 min and 3.502 min. The approach was found to be linear with the variety of 9-36 µg/ml and 40-240 μg/ml for LP and SB respectively, the assay of estimated compounds were found to be 99.65% and 99.73% w/v for LP and SB respectively. Conclusion: The pressured samples changed into analyzed and this proposed a technique turned into determined to be particular and stability indicating as no interfering peaks of decay compound and excipients were observed. Hence, the approach was easy and economical that may be efficiently applied for simultaneous estimation of both LP and SB in bulk and combination tablet system

A REVIEW ON OPTIMIZATION OF DRUG DELIVERY SYSTEM WITH EXPERIMENTAL DESIGNS

The present review article aims at determining the various possible techniques available to enhance the quality, safety and efficacy of pharmaceutical formulations by exploring most suitable and practically applicable experimental designs and optimization techniques. As we know that pharmaceutical industries are constantly in search of novel ideas to improve quality by various optimization techniques, hence in present review article we shall discuss latest optimization techniques and experimental designs to achieve the best combination of product and process characteristics under the given set of conditions. Experimental designs and optimization techniques are the tools that are simultaneously and systematically used to identify various types of problems that may influence research, development and production of pharmaceutical formulations. These are organized an approach to determine the relationship between the factors affecting a process and the output of that process. The screening methods discussed here include factorial design, fractional factorial designs, full factorial design, mixture designs etc. Recently, different software has been used in implementing optimization techniques in pharmaceutical products to enhance product quality by using most suitable available facilities

Priprava, in vitro i in vivo evaluacija bioadhezivnih mikrosfera s algino-pektinom: ispitivanje utjecaja polimera pomoću multiple poredbene analize

Ionotropic gelation was used to entrap aceclofenac into algino-pectinate bioadhesive microspheres as a potential drug carrier for the oral delivery of this anti-inflammatory drug. Microspheres were investigated in vitro for possible sustained drug release and their use in vivo as a gastroprotective system for aceclofenac. Polymer concentration and polymer/drug ratio were analyzed for their influence on microsphere properties. The microspheres exhibited good bioadhesive property and showed high drug entrapment efficiency. Drug release profiles exhibited faster release of aceclofenac from alginate microspheres whereas algino-pectinate microspheres showed prolonged release. Dunett\u27s multiple comparison analyis suggested a significant difference in percent inhibition of paw edema when the optimized formulation was compared to pure drug. It was concluded that the algino-pectinate bioadhesive formulations exhibit promising properties of a sustained release form for aceclofenac and that they provide distinct tissue protection in the stomach.U radu je opisana priprava algino-pektinskih bioadhezivnih mikrosfera protuupalnog lijeka aceklofenaka metodom ionotropnog geliranja. In vitro je ispitivana mogućnost postupnog oslobađanja ljekovite tvari iz mikrosfera te mogućnost upotrebe mikrosfera kao gastroprotektivnog sustava za isporuku aceklofenaka in vivo. Ispitivan je utjecaj koncentracije polimera i omjera polimera i lijeka na svojstva mikrosfera. Mikrosfere su bile bioahezivne i sadržavale su veliki udio lijeka. Oslobađanje aceklofenaka iz alginatnih mikrosfera bilo je brže, a iz mikrosfera s algino-pektinom usporeno. Dunnetova multipla analiza ukazuje na značajnu razliku u postotku inhibicije edema šape kada se usporede optimizirana formulacija i čista ljekovita tvar. Može se zaključiti da su bioadhezivne mikrosfere s algino-pektinom povoljne za usporeno oslobađanje aceklofenaka te da pružaju umjerenu zaštitu sluznice želuca

ENHANCEMENT OF THERAPEUTIC WINDOW OF METFORMIN HYDROCHLORIDE BY FABRICATION OF MICROSPHERES COMPRISING POLYMERIC INCULCATION WITH SEMI-SYNTHETIC AND SYNTHETIC POLYMERS BY IMPLEMENTATION OF BOX-BEHNKEN DESIGN

Objective: Innovative enhancement of therapeutic window of Metformin hydrochloride (MFH) and bioavailability through mucoadhesive microspheres by polymeric inculcation of hydroxypropyl methylcellulose K4M grade (HPMC K4M), hydroxypropyl methylcellulose K100M grade (HPMC K100M) and Kollidon SR grade (KS). Methods: Controlled release system was developed by incorporating semi-synthetic and synthetic polymers by modified solvent evaporation technique. Fabrication of mucoadhesive microspheres was designed by the implementation of experimental designs to obtain most optimum concentration of selected factors. The method was optimized by Box Behnken design (BBD) with selected factors as concentrations of semi-synthetic and synthetic polymer with stirring speed influence for the obtained responses that were mean particle size (Y1) entrapment efficiency of drug (Y2) and percent mucoadhesion (Y3). Microspheres were characterized for particle size, entrapment efficiency of drug, ex-vivo mucoadhesion study, in vitro study, Fourier transform infrared spectroscopy (FTIR), x-ray diffraction (XRD) detection and H1 Nuclear magnetic resonance (NMR) quantification for optimized formulation. Results: Implementation of response surface method software for BBD yielded stable microspheres with mean particle size 274 µm, entrapment efficiency of drug 85.07% and percent mucoadhesion 67.03% for optimized formulation F5. Conclusion: Bridging of MFH with the highly innovative combination of semi-synthetic and synthetic polymers yielded stable, cost-effective microspheres with improved bioavailability with controlled-release effect as till date no literature is available that provide information with selected polymeric combination and analytical characterization

Use of “observation skills” as a teaching/learning strategy in primary science classroom

Observation skill is a central science process skill and can be used as a teaching/learning strategy in science classrooms to enhance students\u27 scientific attitude and learning. Observation skill is critical for gaining command on other science process skills. It helps in widening the conceptual understanding by children of things around them and also in promoting their natural curiosity. This study is based on aspects of observation strategy extracted from the literature and implemented in one of the government schools in Pakistan. The prevailing practice of science in most of the schools in Pakistan is teacher-oriented and teachers think of themselves as dispenser of information and indulge in expository teaching. The part of students in such teaching/learning discourse is that of passive spectators. Children\u27s prior experiences and observations are usually not taken into account, especially in primary schools. The intent of this study was to introduce observation as a teaching/learning strategy in primary science classrooms using peer coaching as a model. Additional objectives of study were to find out the views of the teacher about the use of observation as a teaching/learning strategy, possibilities for its use and challenges encountered during teaching. During the process I found I focused more on that than the development of the teacher. The reason could be my desire to see how and what the outcome of observation as a teaching/learning strategy would be. The results of the study showed that observation as a teaching/ learning strategy has considerable impact on altering the classroom milieu. Moreover, the findings indicate that observation, as a teaching/learning strategy is very effective in engaging students in exploring their surroundings by using their senses to the maximum. In addition, it helps a teacher to attain maximum participation of the students. The use of observation as a teaching/learning strategy fosters pupils\u27 enthusiasm, curiosity, and act as an impetus in learning. As far as the teacher learning is concerned I found that certain factors foster teacher\u27s learning such as teacher\u27s openness to learning, prior experience, pedagogical content knowledge. On the other hand, factors which hindered teacher learning include having a defensive attitude, are general attitude regarding teaching-learning discourse. Action research was the strategy used for this study, a methodology usually adopted by educators to improve the existing practices or situation. This strategy has benefited many people, for instance the co-teacher, the students involved in the study and myself, as I was more interested in learning to use the observation skill as a teaching/ learning strategy for enhancing students\u27 use of their maximum senses for collecting information and learning of science in particular. Different strategies used for introducing observation as a teaching/learning strategy included unfocused, focused observations using natural settings. Furthermore, probing, repetition for refining observations, comparing and contrasting things were a few that helped in achieving the intended outcomes

Nationwide Distribution of Dengue Virus Type 3 (DENV-3) Genotype I and Emergence of DENV-3 Genotype III during the 2019 Outbreak in Bangladesh

Bangladesh is an endemic region of dengue fever and experienced an unprecedented large outbreak with more than 100,000 confirmed cases in 2019. To understand the prevalence of dengue antibody in patients and molecular epidemiological characteristics of dengue virus (DENV) in this outbreak, a total of 179 blood samples were collected from patients in 10 districts (seven divisions) covering nearly the whole country from August to December 2019. DENV NS-1 was detected in 162 samples, among which DENV-specific IgM was positive in 119 samples (73.5%), including 60.5% samples also positive for DENV-specific IgG. Sequencing of the partial C-prM gene and its phylogenetic analysis revealed predominance of DENV type 3 genotype I, accounting for 93% of samples examined. DENV-3 genotype III was identified in two samples from separate districts, and only one DENV-2 cosmopolitan genotype was found in the capital city, Dhaka. These findings suggest the predominance of DENV-3 genotype I and occurrence of DENV-3 genotype III, associated with increased incidence of recent secondary infection in Bangladesh in 2019

Exploring Natural Immune Responses to <i>Shigella</i> Exposure Using Multiplex Bead Assays on Dried Blood Spots in High-Burden Countries: Protocol From a Multisite Diarrhea Surveillance Study.

BackgroundMolecular diagnostics on human fecal samples have identified a larger burden of shigellosis than previously appreciated by culture. Evidence of fold changes in immunoglobulin G (IgG) to conserved and type-specific Shigella antigens could be used to validate the molecular assignment of type-specific Shigella as the etiology of acute diarrhea and support polymerase chain reaction (PCR)-based microbiologic end points for vaccine trials.MethodsWe will test dried blood spots collected at enrollment and 4 weeks later using bead-based immunoassays for IgG to invasion plasmid antigen B and type-specific lipopolysaccharide O-antigen for Shigella flexneri 1b, 2a, 3a, and 6 and Shigella sonnei in Shigella-positive cases and age-, site-, and season-matched test-negative controls from all sites in the Enterics for Global Health (EFGH) Shigella surveillance study. Fold antibody responses will be compared between culture-positive, culture-negative but PCR-attributable, and PCR-positive but not attributable cases and test-negative controls. Age- and site-specific seroprevalence distributions will be identified, and the association between baseline antibodies and Shigella attribution will be estimated.ConclusionsThe integration of these assays into the EFGH study will help support PCR-based attribution of acute diarrhea to type-specific Shigella, describe the baseline seroprevalence of conserved and type-specific Shigella antibodies, and support correlates of protection for immunity to Shigella diarrhea. These insights can help support the development and evaluation of Shigella vaccine candidates

Microbiological Methods Used in the Enterics for Global Health <i>Shigella</i> Surveillance Study

Funder: UKRI; DOI: https://doi.org/10.13039/100014013Abstract Background Shigella is a major cause of diarrhea in young children worldwide. Multiple vaccines targeting Shigella are in development, and phase 3 clinical trials are imminent to determine efficacy against shigellosis. Methods The Enterics for Global Health (EFGH) Shigella surveillance study is designed to determine the incidence of medically attended shigellosis in 6- to 35-month-old children in 7 resource-limited settings. Here, we describe the microbiological methods used to isolate and identify Shigella. We developed a standardized laboratory protocol for isolation and identification of Shigella by culture. This protocol was implemented across all 7 sites, ensuring consistency and comparability of results. Secondary objectives of the study are to determine the antibiotic resistance profiles of Shigella, compare isolation of Shigella from rectal swabs versus whole stool, and compare isolation of Shigella following transport of rectal swabs in Cary-Blair versus a modified buffered glycerol saline transport medium. Conclusions Data generated from EFGH using culture methods described herein can potentially be used for microbiological endpoints in future phase 3 clinical trials to evaluate vaccines against shigellosis and for other clinical and public health studies focused on these organisms. </jats:sec