Is obstetric triage necessary?

Background: The aim was to determine the number and type of patients admitted in the labour and delivery unit and whether a formal triage would improve efficiency.Methods: All patients entering the unit were analyzed for a period of two months: July and August 2013.Results: The 990 patients during the study period were from three areas, the OPD, the ward and emergency visits to the labour unit. The reason for the visit and the number of cases seen was analyzed. This was correlated with the number of deliveries. Most patients were generally seen within 5 to 10 minutes, however in a few cases there was a delay of up to half an hour when the nurses were held up by a delivery or another emergency.Conclusions: Obstetric triage would improve efficiency of care and reduce waiting time. The suggestions for improvement were also discussed. There should be clear guidelines and protocols for the initial assessment and action for each level of severity

Surveillance of surgical site infections to determine incidence, risk factors and microbiologic spectrum following obstetric and gynaecological surgeries

Background: Surgical site infections (SSI) are one of the major health problems throughout the world with an incidence of 3%-16%. Hospital acquired surgical site infection is further complicated by the emergence of multi drug resistant strains. SSI surveillance is an established monitoring tool and has been shown to reduce infection rates. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stay, need for readmission, high end antibiotic treatment and re-surgery. This study was undertaken to determine the incidence, risk factors, and microbiological spectrum of surgical site infections and to identify the multidrug resistant strains.  Analysis of the effectiveness of the existing surveillance methods was also done.Methods: This retrospective study was done for a period of 1-year form Jan 2016 to Dec 2016. All patients with infection following caesarean section and abdominal and vaginal hysterectomy were included. Laparoscopic surgery and patients with preexisting infection were excluded.Results: Incidence of SSI in present study is 5.27%. The major risk factors identified were obesity, diabetes and prolonged operating time.  The commonest infective organism was Klebsiella Pneumoniae in 37% of which 19% were ESBL producing and 3.8% were carbapenemase producing. E. coli was identified in 20% of isolates. The incidence of ESBL in both isolates was higher.Conclusions: Regular audit of SSIs is a very effective tool to analyse risk factors, identify causes and plan strategies to prevent infection

Universal screening for hypothyroidism in pregnancy: is it necessary?

Background: Thyroid diseases are one of the commonest endocrine disorders affecting women of reproductive age group, and hence constitute one important disorders complicating pregnancy. The objective of this study was to determine the importance of universal screening for hypothyroidism in pregnancy at the first antenatal visit and to formulate whether this routine screening is mandatory in our country.Methods: This retrospective study was conducted in the year 2018 at PSG IMSR Hospital for all pregnant women who attended the first antenatal visit between Jan 2012 to Dec 2012 after obtaining ethical clearance. Pregnant women who were already taking treatment for hypothyroidism, diabetes mellitus, hypertension and those pregnant women who lost their follow up were excluded from the study.Results: The incidence of subclinical hypothyroidism among antenatal women were 7.06%. In our study the maternal complications like anemia 12 (8%), preeclampsia 26 (17.3%), gestational diabetes 25 (16.7%), fetal growth restriction 8 (5.3%), Oligohydramnios 13 (8.7%), pre mature rupture of membranes 25 (16.7%), placental abruption in 2 (1.33%), APLA syndrome 2 (1.33%), low birth weight 26 (17.3%) were observed.Conclusions: Universal screening for hypothyroidism is recommended for all antenatal women especially in iodine depleted country like India

Parallel-cascade realizations and approximations of truncated volterra systems

Journal ArticleThis paper introduces parallel-cascade realizations of truncated Volterra systems with arbitrary, but finite order of nonlinearity. Parallel-cascade realizations implement higher-order Volterra systems using parallel and multiplicative combinations of lower-order Volterra systems. Such realizations are very modular and therefore well-suited for VLSI implementation. A systematic way of approximating higher-order Volterra systems in parallel-cascade form using a reduced number of branches and a bound on the mean-square error in the output signals caused by such approximate realizations are derived in this paper. A variation of the parallel-cascade structure in which a pth order Volterra filter is implemented as a parallel combination of linear filters whose outputs are raised to the pth power is also described in this paper

Adaptive parallel-cascade truncated volterra filters

Journal ArticleAbstract-This paper studies adaptive truncated Volterra filters employing parallel-cascade structures. Parallel-cascade realizations implement higher order Volterra systems a s a parallel connection of multiplicative combinations of lower order truncated Volterra systems. A normalized LMS adaptive filter is developed, and its performance capabilities are evaluated using a series of simulation experiments. The experimental results indicate that the normalized LMS adaptive parallel-cascade Volterra filter has superior convergence properties over several competing structures. This paper also includes an experiment that demonstrates the capability of the parallel-cascade adaptive system to reduce its implementation complexity by using fewer than the maximum number of branches required for the most general realization of the system

Parallel-cascade realizations and approximations of truncated volterra systems

Journal ArticleAbstract This paper introduces parallel-cascade realizations of truncated Volterra systems with arbitrary, but finite order of nonlinearity. Parallel-cascade realizations implement higher-order Volterra systems using parallel and multiplicative combinations of lower-order Volterra systems. Such realizations are very modular and therefore well-suited for VLSI implementation. A Systematic way of approximating higher-order Volterra systems in parallel-cascade form using a reduced number of branches and a bound on the mean-square error in the output signals caused by such approximate realizations are derived in this paper. A variation of the parallel-cascade structure in which a pth order Volterra filter is implemented as a parallel combination of linear filters whose outputs are raised to the pth power is also described in this paper

A clinical study of cutaneous changes in pregnancy

AbstractBackground/objectivePregnant women experience a myriad of physiological and metabolic changes that affect different organ systems in the body. Cutaneous and appendageal alterations that manifest during pregnancy are largely modulated by hormonal, immunologic, and metabolic factors. Detailed reports encompassing physiological changes and specific dermatoses of pregnancy and effects of various dermatoses on pregnant women are scanty in literature. This study was conducted to examine in detail both physiological changes and specific dermatoses. The cutaneous changes are divided into physiological changes, skin diseases aggravated by pregnancy, and specific dermatoses of pregnancy. The objectives were to study the various cutaneous changes of pregnancy and to know the proportion of these cutaneous manifestations in pregnant women.MethodsThis study included 600 pregnant women attending the Obstetrics and Gynecology Department of a tertiary teaching hospital in Northern Kerala, India. Detailed history elicitation and complete physical and dermatological examination were performed. Skin biopsy was performed in relevant cases.ResultsCutaneous changes were seen in a majority of patients, of which physiological changes were the most common (99%). The most common cutaneous manifestation was hyperpigmentation (526; 87.6%), followed by striae gravidarum (72.8%). Other changes were vascular, including pedal edema (10%), pregnancy gingivitis (1.8%), and varicose veins (1%). Infections were the common dermatological problem in this study group. The most common infections were vulvovaginal candidiasis (21%), Tinea versicolor (6%), scabies (2.8%), dermatophytosis (1.5%), and sexually transmitted infection (0.5%). Specific dermatoses were seen in 12 cases (2%), with the most common being pruritic urticarial papules and plaques of pregnancy (1.3%).ConclusionPregnant women are prone to suffer from a wide range of dermatological problems apart from specific dermatoses of pregnancy. The study emphasizes the need for a detailed and meticulous examination of these patients to detect these various disorders

Outcome of emergency cerclage for advanced cervical dilatation: a retrospective analysis

Background: The objective was to evaluate the outcome of late second trimester emergency cerclage in patients with advanced cervical dilatation with bulging membranes.Methods: Setting: department of obstetrics and gynaecology, PSG Institute of medical sciences & research, Coimbatore, Tamil Nadu, India. This is a retrospective study of case files of patients who underwent emergency late second trimester cerclage for advanced cervical dilatation with bulging membranes between January 2009 to January 2014. McDonald’s technique was used in all the cases.Results:Altogether, 7 patients (100%) underwent late second trimester  emergency cerclage between 20-28 weeks of gestational age, out of which three  patients (42.86%) had term deliveries (>37w), and 3 patients (42.86 %) carried on their pregnancies to more than 32 weeks resulting in healthy live born babies. Two of them delivered by normal vaginal delivery, 4 underwent LSCS, and one patient had severe abdominal pain with bleeding and draining per vaginum after 3 days of cerclage, in view of which the stitch was removed. Subsequently, the patient expelled a live foetus weighing 620gms, which died in the Neonatal Intensive Care Unit (NICU) after 3 hours. This procedure prolonged the duration of pregnancy in all patients with a mean duration of 70.4 days. The mean gestational age at the time of delivery was 34.33 weeks. The mean birth weight was 2.18 kg and ranged between 1.97 to 2.64 kg. The mean APGAR at one minute was 8/10 and the mean duration of stay in NICU was 1.66 days. All the new-born babies were healthy at the time of discharge. The live birth rate following emergency late second trimester cerclage in this series was 85.75%.  Conclusion:Favourable neonatal outcome can be accomplished in patients with cervical incompetence in the second trimester of pregnancy following emergency cervical suturing, even if performed when the membranes are bulging through the cervix.

A practical approach to assessing and managing sexual dysfunction in multiple sclerosis

Sexual dysfunction is common in both men and women with multiple sclerosis but is often under-reported and undertreated. Neurologists report that a major barrier to discussing sexual dysfunction with patients is their lack of knowledge. Here we review the common presentations of sexual dysfunction, discuss its causes in people with multiple sclerosis, and provide a practical approach for neurologists to assess and manage these problems