Maternal request caesarean sections: fear tops the list

Background: The increasing demand for caesarean delivery on maternal request (CDMR) is adding to the increasing caesarean rates worldwide. Pregnant women and families choose a CDMR for several reasons that include social, economic, and cultural contexts. This study was done in a south Indian state to explore the common local reasons for CDMR, as a first step to reduce this trend. Methods: Prospective observational, semi structured interview-based study of women who had chosen CDMR. Women with multifetal pregnancy and with previous caesarean sections were excluded. The primary outcomes were the reasons to choose a caesarean section over vaginal birth. The reasons were collected and divided into three themes: social and cultural, emotional reasons and personal previous experiences. Results: Ninety-two women gave consent to participate in the study and were interviewed. The most common reason to choose a caesarean in the absence of any medical indication was ‘fear’ of harm to the mother or baby, trauma, or vaginal examinations by 65 out of 92 women (70.65%). Theme of social influence was quoted as the reason by seven (7.6%) and previous personal experience with birth outcomes was cited by three women (3.2%).  The majority chose CDMR in the antenatal period even before they set into labour. Conclusions: Fear was the most common reason for choosing a CDMR, representing a misconception that caesarean birth is a safer, better alternative for the woman and her family. There is a need for change in discussions around antenatal care options, exploration of fears, and support systems to make a better-informed choice

Screening and assessment of laccase producing fungi isolated from different environmental samples

Laccase is a copper-containing polyphenol oxidase that acts on a wide range of substrates. This enzyme is found in many plant species and is widely distributed in fungi including wood-rotting fungi where it is often associated with lignin peroxidase, manganese dependent peroxidase, or both. Because of its importance in bioremediation, fungal cultures were screened for laccase positive production by plate test method using the indicator compound guaiacol. Out of 12 cultures tested, six cultures werefound to be laccase-positive with Stereum ostrea and Phanerochaete chrysosporium being the best potential cultures. Laccase production on 5 different liquid media was compared using these two white rot fungi

Alkaline Protease Bioprocess Optimization through Response Surface Methodology for Alkaliphilic Bacillus subtilis SHmIIIa Mutant Strain from Warangal-Telangana

The present investigations were carried out to enhance the alkaline protease production by a mutant strain Bacillus subtilis SH2 isolated from slaughter house soils of Warangal and improved through two-tier mutagenesis first by UV and then HNO2. Initially three efficient mutants with over production of alkaline protease were identified and among them only one stable mutant SHmIIIa was selected for further improvement through popular Response Surface Methodology of the FFCCD. Only X2 agitation, X6 KH2PO4 and interactive effects of X3*X3 inoculum, X4*X5 glucose and peptone have shown a significant improvement. The maximum alkaline protease production was achieved with the medium containing of X1 pH 9.8; X2 agitation 237.5 rpm; X3, inoculum size 4%; X4, glucose 6 g/L; X5, peptone 4g/L and X6, KH2PO4 2 g/L; under batch fermentative conditions with 33.33 fold increase

Counter-intuitive evaporation in nanofluids droplets due to stick-slip nature

We experimentally investigate the evaporation characteristics of a sessile ethanol droplet containing Al$_2$O$_3$ and Cu nanoparticles of sizes 25 nm and 75 nm on a heated substrate using shadowgraphy and infrared imaging techniques. Our results demonstrate that the droplet contact line dynamics resulting from the presence of various nanoparticles plays a dominant role in the evaporation process. This is in contrast to the widely-held assumption that the enhanced evaporation rate observed in sessile nanofluid droplets is due to the higher thermal conductivity of the added nanoparticles. We observe that even though the thermal conductivity of Al$_2$O$_3$ is an order of magnitude lower than that of Cu, droplets containing 25 nm-sized Al$_2$O$_3$ exhibit pinned contact line dynamics and evaporate much more rapidly than droplets containing Cu nanoparticles of both sizes and 75 nm Al$_2$O$_3$ nanoparticles that exhibit stick-slip behaviour. We also found that the droplets with different nanoparticles display distinct thermal patterns due to the difference in contact line behaviour, which alters the heat transfer inside the droplets. We establish this counter-intuitive observation by analysing the temporal variations of the perimeter, free surface area, and deposition patterns on the substrate.Comment: 30 pages, 7 figures, Journal-Langmui

PRESCRIPTION PATTERN OF ANTIBIOTICS AND THEIR APPROPRIATENESS IN PATIENTS WITH CHRONIC KIDNEY DISEASE-AN OBSERVATIONAL STUDY IN A TERTIARY CARE TEACHING HOSPITAL IN SOUTH INDIA

Objective: The primary objective of the study was to assess the prescribing pattern of antimicrobial agents in patients with chronic kidney disease. The secondary objectives of this study are to assess antibiotic appropriateness and dose optimization in patients with chronic kidney disease in relation to their comorbidities. Methods: A retrospective study was conducted, and medical records of all patients with CKD who were admitted in the nephrology department of Sri Venkateswara Institute of Medical Sciences, Tirupati, during Jan 2018-Dec 2018 were reviewed for antibiotic prescriptions. A total of 200 medical records were selected and assessed for antimicrobial prescriptions. A p-value <0.05 was considered significant throughout the statistical analysis. Results: Analysis showed that overall 163 drugs were prescribed to CKD patients, of which nearly 96 (58.9%) required dosage adjustment. Of those 163 drugs, the majority N= 25 (26%), were unadjusted, and the remaining N = 71 (74%) were properly adjusted. The length of hospitalization of CKD patients was below 7 was 13.5%, above 7 was 86.5%. Mean and SD was 10.27±7.18 d, (Range: 1–35 d). The Chi-square analysis confirmed that out of the seven studied variables, two i.e. Length of stay days; p<0.001. Conclusion: It is concluded that the occurrence of medication dosing errors was moderate in hospitalized chronic kidney disease patients in our study. Nearly 20% of patients who had prolonged stays were prescribed antibiotics for a prolonged period. The predictors of medication dosing errors in CKD patients were the severe-to-end stages of chronic kidney disease, the number of prescribed antibiotics, and the length of hospitalization

Fluid dynamics of respiratory droplets in the context of COVID-19: Airborne and surfaceborne transmissions

The World Health Organization has declared COVID-19 a global pandemic. Several countries have experienced repeated periods of major spreading over the last two years. Many people have lost their lives, employment, and the socioeconomic situation has been severely impacted. Thus, it is considered to be one of the major health and economic disasters in modern history. Over the last two years, several researchers have contributed significantly to the study of droplet formation, transmission, and lifetime in the context of understanding the spread of such respiratory infections from a fluid dynamics perspective. The current review emphasizes the numerous ways in which fluid dynamics aids in the comprehension of these aspects. The biology of the virus, as well as other statistical studies to forecast the pandemic, is significant, but they are not included in this review

Branchial Anomalies: Diagnosis and Management

Objective. To find out the incidence of involvement of individual arches, anatomical types of lesions, the age and sex incidence, the site and side of predilection, the common clinical features, the common investigations, treatment, and complications of the different anomalies. Setting. Academic Department of Otolaryngology, Head and Neck Surgery. Design. A 10 year retrospective study. Participants. 30 patients with clinically proven branchial anomalies including patients with bilateral disease totaling 34 lesions. Main Outcome Measures. The demographical data, clinical features, type of branchial anomalies, and the management details were recorded and analyzed. Results and Observations. The mean age of presentation was 18.67 years. Male to female sex ratio was 1.27 : 1 with a male preponderance. Of the 34 lesions, maximum incidence was of second arch anomalies (50%) followed by first arch. We had two cases each of third and fourth arch anomalies. Only 1 (3.3%) patients of the 30 presented with lesion at birth. The most common pathological type of lesions was fistula (58.82%) followed by cyst. 41.18% of the lesions occurred on the right side. All the patients underwent surgical excision. None of our patients had involvement of facial nerve in first branchial anomaly. All patients had tracts going superficial to the facial nerve. Conclusion. Confirming the extent of the tract is mandatory before any surgery as these lesions pass in relation to some of the most vital structures of the neck. Surgery should always be the treatment option. injection of dye, microscopic removal and inclusion of surrounding tissue while excising the tract leads to a decreased incidence of recurrence