Doppler velocimetry of umbilical, and middle cerebral arteries in the prediction of fetal outcome

Background: Doppler ultrasound offers a unique non-invasive technology for investigating fetal, feto placental and utero placental circulation Intrauterine growth restriction is associated with increased perinatal morbidity and mortality.Methods: A hospital based descriptive study of Doppler velocimetry of umbilical Artery and Middle cerebral Artery was carried out in the Department of Obstetrics and Gynecology Pariyaram Medical College over a period of 1 year – April 2016 to March 2017. A total of 180 patients with clinically IUGR were selected for the study. Close monitoring done with daily NST and repeated Doppler study.Results: The S/D ratio in Umbilical artery and RI ratio of MCA is valuable for monitoring growth retarded and small for gestational age fetuses and to take decision for early termination of pregnancy. In our study, perinatal outcome is very good, only 3 NND happened. i.e., due to extreme prematurity.Conclusions: Colour Doppler helps in detection of compromised fetuses in high risk pregnancies like PIH, IUGR and other risk factors likely to cause placental insufficiency.

Low platelet counts in pregnancy: an alarm signal for abruption!

Background: Thrombocytopenia, defined as a platelet count less than 150 million/mm3, affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy.Methods: We studied all patients with thrombocytopenia in pregnancy from June 2012 to May 2013. There were 86 patients recruited into the study. Pregnant women with preeclampsia and suspected connective tissue disorder were also screened for thrombocytopenia. All women with platelet count of <1.50,000/µl during the study period were included.Results: Patients were grouped in to mild thrombocytopenia (platelet 100,000-149,999/µl), moderate thrombocytopenia (platelet 50,000-99,999/µl) and severe thrombocytopenia (platelet <49,999/µl. Pregnancy specific cause of thrombocytopenia was in 63 (73.2%) women and non-pregnancy specific were in 23(26.7%) patients.Conclusions: Preeclampsia and HELLP syndrome is more common cause of thrombocytopenia in pregnancy. Abruption can occur in patients with severe thrombocytopenia. Though platelet count is not routinely done in pregnancy it is advisable to do so as it may help in detecting gestational thrombocytopenia or other immune related condition

Mediation - the Malaysian Dental Association experience

Objectives: To study the success and failures of the mediation process of complaints from 2004-2007 by the Complaints Bureau Steering Committee and the Public Complaints Bureau Committee of the Malaysian Dental Association (MDA). Methods: Retrospective analysis of complaints from the records at the MDA. Results: There were 41 cases during the three years, most involved surgical procedures (9), endodontics (9), miscellaneous (8), orthodontics (6), restorative problems (6) and prosthetics (2). Chinese patients made the most complaints (67) followed by Malay patients (23), foreigners (7) and Indians (3). 69 of the cases where against dentists working in the KIang Valley, 14 in Johore and the rest in various part of the country. 69 of the cases were successfully mediated, 10 unresolved and the 21 are in various stages of mediation. Conclusion: It is heartening to report that the MDA has successfully mediated in a sizeable number of the complaints which are increasing yearly

Allometric relationships of the dentition of the great White Shark, Carcharodon carcharias, in forensic investigations of shark attacks

As a result of a systematic morphometric study of shark dentitions, a system of notation for describing the location of shark teeth has been developed and is proposed as a standard to be adopted for use in similar studies in the future. The macroscopic morphology of White Shark teeth has been characterised in order to gain quantitative data which might assist in identification of these sharks from bite marks on victims or objects or from shark carcasses. Using these data, a nomogram has been developed which can be used to estimate the body length of a White Shark from measurements of tooth or bite mark morphology. An example of the forensic application of such allometric data is provided as it applied to a recent fatal attack on a diver by a White Shark. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down

Quantitative forensic evaluation of bite marks with the aid of a shape analysis computer program: Part 1; the development of 'SCIP' and the Similarity Index

Bite marks left on human tissue and bitten material have become an important aspect of scientific evidence used for the conviction or acquittal of a suspect. Expert opinion has often been based on subjective comparisons rather than any objective metrical analysis and many experts will agree that there is a need to employ additional comparative tests to achieve unbiased objectivity in their investigation. In this study, an interactive shape analysis computer program ('SCIP' - Shape Comparison Interactive Program) has been employed in an attempt to derive experimentally a quantitative comparison, in the form of a Similarity Index (S.I.), between the 'offender's' teeth and the bite marks produced on a standard flat wax form. The S.I. values obtained using 'SCIP' were evaluated in a variety of experimental bite mark situations. It was found that in no case could the S.I. values produced by comparison of the bite mark with the dental casts from non-perpetrators be confused with the much lower S.I. from comparison of the bite mark with the dental cast of the perpetrator. The use of the Similarity Index derived using the 'SCIP' program is recommended as a simple, accurate and objective means of comparing bite marks in suitable forensic cases. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down

Forensic implications of the variation in morphology of marginal serrations on the teeth of the great white shark

The teeth of the Great White Shark have been examined to ascertain whether there is any commonality in the arrangement or number of the marginal serrations (peaks) or, indeed, whether individual sharks have a unique pattern of shapes or size of the peaks. The teeth of the White Shark are characteristic in size and shape with serrations along almost the entire mesial and distal margins. This study has revealed no consistent pattern of size or arrangement of the marginal serrations that was sufficiently characteristic within an individual shark to serve as a reliable index of identification of a tooth as originating from that particular shark. Nonetheless, the serrations are sufficiently distinctive to enable the potential identification of an individual tooth as having been the cause of a particular bitemark. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down

LAVH or TAH – choosing it wise and making it safe

Background: Hysterectomy is the most commonly performed surgery in our gynaecological practice, abdominal route being the most common. Here we compare the various features and outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH).Methods: The study design is a retrospective observational study. Outcome measures were indication, duration, complications of surgery, post op recovery and cost following TAH and LAVH.Results: A total of 116 cases underwent hysterectomy. Of these 98 underwent TAH and 18 underwent LAVH. Commonest indication for TAH in our study was fibroid followed by abnormal uterine bleeding (AUB); whereas in LAVH it was AUB followed by fibroid. Mean operating time in TAH was 118 minutes whereas in LAVH it was 166 minutes. One patient who underwent LAVH had ureteric injury and another had vault abscess. There were no major complications among TAH cases. A few patients had minor complications like fever, wound infection and urinary tract infection following TAH whereas fever was the only minor complication seen in a minority of the LAVH patients. Mean fall in haemoglobin in TAH was 1.05 gm% whereas in LAVH it was 0.95 gm%. None of the patients required postoperative blood transfusion. A few patients following TAH required additional analgesics apart from routine whereas in LAVH none required it. Mean duration of hospital stay following TAH was 6.84 days where as in LAVH it was 3.1 days. Mean hospital expenses in TAH were INR 28480, while for LAVH it was 44360.Conclusions: Undoubtedly expertise is the decisive factor behind the success of hysterectomy. LAVH though advantageous in many aspects like less post operative pain and cosmetic benefits, it could be technically demanding with availability only in well-equipped centres and cost factors. Surgeons need to be trained in all modalities of hysterectomy

Parents' perceived obstacles to pediatric clinical trial participation: Findings from the clinical trials transformation initiative.

Enrollment of children into pediatric clinical trials remains challenging. More effective strategies to improve recruitment of children into trials are needed. This study used in-depth qualitative interviews with parents who were approached to enroll their children in a clinical trial in order to gain an understanding of the barriers to pediatric clinical trial participation. Twenty-four parents whose children had been offered the opportunity to participate in a clinical trial were interviewed: 19 whose children had participated in at least 1 clinical trial and 5 who had declined participation in any trial. Each study aspect, from the initial explanation of the study to the end of the study, can affect the willingness of parents to consent to the proposed study and future studies. Establishing trust, appropriate timing, a transparent discussion of risks and benefits oriented to the layperson, and providing motivation for children to participate were key factors that impacted parents' decisions. In order for clinical trial accrual to be successful, parents' priorities and considerations must be a central focus, beginning with initial trial design. The recommendations from the parents who participated in this study can be used to support budget allocations that ensure adequate training of study staff and improved staffing on nights and weekends. Studies of parent responses in outpatient settings and additional inpatient settings will provide valuable information on the consent process from the child's and parent's perspectives. Further studies are needed to explore whether implementation of such strategies will result in improved recruitment for pediatric clinical trials

Effects of mineral nitrogen and Bradyrhizobium inoculation on growth and iron nutrition of groundnut

Experiments were conducted in a glasshouse to determine the effects of the mineral N supplied as ammonium nitrate andBradyrhizobium inoculation on the growth and iron nutrition of nodulating and non-nodulating groundnut (Arachis hypogaea L.) lines. In a sterilized sand-vermiculite medium supplied with N-free nutrient solution (pH 7.0), inoculation of nodulating groundnut withBradyrhizobium strain NC 43.3 enhanced dry matter production and O-phenanthroline extractable iron and N contents of the plants. The supply of mineral N at a rate of 100 mg N L–1 (as NH4NO3) through deionized water (pH 8.5) induced iron chlorosis symptoms in the nodulating groundnuts grown in Vertisols, but these symptoms were not observed at higher N levels (200–400 mg N L–1). The induced chlorosis was only partially corrected by inoculation withBradyrhizobium strains NC 92 and NC 43.3. The iron deficiency chlorosis was, however, corrected by application of higher rates of ammonium nitrate

Perceived barriers to pediatrician and family practitioner participation in pediatric clinical trials: Findings from the Clinical Trials Transformation Initiative.

Despite legislation to stimulate pediatric drug development through clinical trials, enrolling children in trials continues to be challenging. Non-investigator (those who have never served as a clinical trial investigator) providers are essential to recruitment of pediatric patients, but little is known regarding the specific barriers that limit pediatric providers from participating in and referring their patients to clinical trials. We conducted an online survey of pediatric providers from a wide variety of practice types across the United States to evaluate their attitudes and awareness of pediatric clinical trials. Using a 4-point Likert scale, providers described their perception of potential barriers to their practice serving as a site for pediatric clinical trials. Of the 136 providers surveyed, 52/136 (38%) had previously referred a pediatric patient to a trial, and only 17/136 (12%) had ever been an investigator for a pediatric trial. Lack of awareness of existing pediatric trials was a major barrier to patient referral by providers, in addition to consideration of trial risks, distance to the site, and time needed to discuss trial participation with parents. Overall, providers perceived greater challenges related to parental concerns and parent or child logistical barriers than study implementation and ethics or regulatory barriers as barriers to their practice serving as a trial site. Providers who had previously been an investigator for a pediatric trial were less likely to be concerned with potential barriers than non-investigators. Understanding the barriers that limit pediatric providers from collaboration or inhibit their participation is key to designing effective interventions to optimize pediatric trial participation