Urinary Bladder Calculus as a Rare Cause of Obstructed Labour: A Series of Three Rare Cases

Obstructed labour by large urinary bladder stones is one of the rare complications. Very small number of cases have been described in available literature. The diagnosis is generally based on the history of patient, their clinical evaluation and ultrasonography scans during pregnancy. Majority of antenatal cases in rural areas come first time in Primary Healthcare Centre (PHC) with labour pain and usually without any previous ultrasound scans. These cases are referred to higher centres due to prolonged obstructed labour. Although rare, but one should consider a large urinary bladder calculus as a cause of obstructed labour as early diagnosis and timely management of urinary bladder stones can prevent various complications like mechanical dystocia and Vesico-vaginal Fistula (VVF). Here, authors reported three cases of a large urinary bladder calculus causing obstructed labour. Caesarean section was done for obstructed labour and cystolithotomy was performed simultaneously in all three cases

An evaluation on clinical outline and management of mastalgia

Introduction: Mastalgia is repeatedly associated with breast nodularity which may be soft or it may occur without a distinct lump. A quantity ofbreast nodularity and mastalgia have been established in normal population. Materials and Methods: This study was conducted from May 2019 to June 2021. 110 patients were included in the study. A detailed study of clinical history of all the breast pathologies causing mastalgia was studied.Patients’ past records related to breast pain were noted in the OPD. During detailed clinical examination, if any lumps were observed suspicious of carcinoma then these patients were advised radiographic investigations. Results: Various causes of mastalgia were observed: 51 (46.3%)due to fibroadenosis, 14 (12.7%) due to fibroadenoma, 11 (10%) due to mastitis, 08(7.2%)duetobreastabscess,04(3.6%)due to duct ectasia, 03(2.7%) due to galactocoele, 02 (2.7%) due to breast carcinoma and 17(15.4%) due to non-specific extra-mammary cause. Conclusion: In this study, the response to therapy was best with danazol, followed by bromocriptine and to topical NSAIDs. Danazol and bromocriptine are effective in treatment of mastalgia, though they show different side effect profiles and varying patient compliance

Propranolol for management of Infantile Haemangioma: A Single Centre Experience

Objective: Infantile hemangiomas are the most common benign tumour in infancy. Propranolol has recently been introduced as therapeutic agent for treating hemangiomas. This study explores the impact of Propranolol on hemangiomas. Study Design: Prospective study. Materials and Methods: Propranolol was given to 32 children (19 girls and 13 boys) having hemangiomas between age of 3 weeks to 12 months at a dose of 2 mg/kg per day, in 2 or 3 divided doses. Total duration of study period was one year from July 2013 to June 2014. Serial photographs were taken at 4-6 weeks interval during the course of their therapy to record clinical response. Results: out of 32 patients 31 patients showed improvement in their hemangiomas by reduction in size and change in color during propranolol therapy. Results were determined as complete resolution (n- 5, 15.6%), ongoing resolution (n-26, 81.2%). No side effects of propranolol was observed in any patient. Conclusions: Propranolol appears to be a valuable and effective treatment option for infantile hemangiomas. Propranolol is likely to revolutionize the treatment of hemangiomas

Analysis of 5-enolpyruvyl shikimate 3-phosphate (EPSP) synthase enzyme from different plants 1

Abstract- 5-enolpyruvylshikimate 3-phosphate (EPSP) synthase, an enzyme used in biosynthesis of aromatic amino acids in plants, many bacteria, and microbes, is a prime target for drugs and herbicides. The herbicide glyphosate (N-phosphonomethyl glycine) is a potent reversible inhibitor of the 5-enolpyruvylshikimate-3-phosphate (EPSP) synthase activity as it is competitive with respect to phosphoenolpyruvate and uncompetitive with respect to shikimate-3-phosphate. It is important to study this enzyme for elucidation of the active site of EPSP synthase and especially of the binding pattern of glyphosate provides a valuable roadmap for engineering new herbicides and herbicide-resistant crops, as well as new antibiotic and antiparasitic drugs. In this paper, a bioinformatics and molecular modeling approach was adopted to explore properties and structure of enzymes from different plants viz., Nicotian

Facilitators and barriers for implementation of a novel resuscitation quality improvement package in public referral hospitals of Nepal

Abstract Background Improving the healthcare providers (HCP) basic resuscitation skills can reduce intrapartum related mortality in low- and middle-income countries. However, the resuscitation intervention’s successful implementation is largely dependent on proper facilitation and context. This study aims to identify the facilitators and barriers for the implementation of a novel resuscitation package as part of the quality improvement project in Nepal. Methods The study used a qualitative descriptive design. The study sites included four purposively chosen public hospitals in Nepal, where the resuscitation package (Helping Babies Breathe [HBB] training, resuscitation equipment and NeoBeat) had been implemented as part of the quality improvement project. Twenty members of the HCP, who were trained and exposed to the package, were selected through convenience sampling to participate in the study interviews. Data were collected through semi-structured interviews conducted via telephone and video calls. Twenty interview data were analyzed with a deductive qualitative content analysis based on the core components of the i-PARiHS framework. Results The findings suggest that there was a move to more systematic resuscitation practices among the staff after the quality improvement project’s implementation. This positive change was supported by a neonatal heart rate monitor (NeoBeat), which guided resuscitation and made it easier. In addition, seeing the positive outcomes of successful resuscitation motivated the HCPs to keep practicing and developing their resuscitation skills. Facilitation by the project staff enabled the change. At the same time, facilitators provided extra support to maintain the equipment, which can be a challenge in terms of sustainability, after the project. Furthermore, a lack of additional resources, an unclear leadership role, and a lack of coordination between nurses and medical doctors were barriers to the implementation of the resuscitation package. Conclusion The introduction of the resuscitation package, as well as the continuous capacity building of local multidisciplinary healthcare staff, is important to continue the accelerated efforts of improving newborn care. To secure sustainable change, facilitation during implementation should focus on exploring local resources to implement the resuscitation package sustainably. Trial Registration Not applicable

Validation of Digital Impressions’ Accuracy Obtained Using Intraoral and Extraoral Scanners: A Systematic Review

Background: At present, the evidence regarding digital impressions’ accuracy recorded by using digital scanners is lacking. This systematic review aimed to evaluate whether the type of scanning (intraoral/extraoral) affects the Accuracy of Digital Impressions. Method: Two independent reviewers performed a systematic search in the database both electronically and manually (PubMed, Ebsco HOST, the Cochrane Library, and Google Scholar) for articles published from 1 January 2010 to 1 December 2022. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42020188765) and followed the PRISMA statement. The question in focus was as follows: Does the type of scanning (intraoral or extraoral) affect the accuracy of digital impression? Results: A total of 449 papers were obtained by searching electronically and manually. In total, 15 complete-text papers qualified for assessment based on eligibility criteria. After reading the full-text articles, five studies were excluded. Ten studies were selected for the qualitative analysis. The qualitative data reported that the accuracy of both types of scanners (intraoral and extraoral) lies within the range of clinical acceptability. Nevertheless, the intraoral scanners seem to be more accurate when compared to the extraoral scanners for a partial arch situation. Conclusions: Scanning type affects the accuracy of the digital impression. Various factors influence the scanning ability. Intraoral scanners seem to be more accurate compared to extraoral scanners for a partial arch situation. More studies comparing the accuracy of the intraoral scanner and extraoral scanner for a complete arch scan and in an in vivo study setting are needed

Omega 76: A designed antimicrobial peptide to combat carbapenem- and tigecycline-resistant Acinetobacter baumannii

Drug resistance is a public health concern that threatens to undermine decades of medical progress. ESKAPE pathogens cause most nosocomial infections, and are frequently resistant to carbapenem antibiotics, usually leaving tigecycline and colistin as the last treatment options. However, increasing tigecycline resistance and colistin's nephrotoxicity severely restrict use of these antibiotics. We have designed antimicrobial peptides using a maximum common subgraph approach. Our best peptide (Omega 76) displayed high efficacy against carbapenem and tigecycline-resistant Acinetobacter baumannii in mice. Mice treated with repeated sublethal doses of Omega 76 displayed no signs of chronic toxicity. Sublethal Omega 76 doses co-administered alongside sublethal colistin doses displayed no additive toxicity. These results indicate that Omega 76 can potentially supplement or replace colistin, especially where nephrotoxicity is a concern. To our knowledge, no other existing antibiotics occupy this clinical niche. Mechanistically, Omega 76 adopts an a-helical structure in membranes, causing rapid membrane disruption, leakage, and bacterial death