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

Rapeseed-Mustard Breeding in India: Scenario, Achievements and Research Needs

Brassica spp., commonly known as rapeseed-mustard, plays a significant role in the Indian economy by providing edible oils, vegetables, condiments and animal feed. Globally, India holds second and third position in rapeseed-mustard area under cultivation and production, respectively. However, anthropogenically accelerated climate change thwarts yield potential of rapeseed-mustard by employing abiotic (drought, flood, temperature variation and salinity) and biotic (disease and insects) stresses. Various approaches such as molecular breeding, pre-breeding, −omics and biotechnological interventions have been used to develop varieties for improved yield and oil quality, climate resilient and resistance or tolerance to abiotic and biotic stresses. In this context, this chapter highlighted the different cytoplasmic male sterility (CMS) sources and their potential use for hybrid development. At the end, this chapter also enlisted salient achievement by the government and non-government institutes and briefly described the future perspective for improvement of rapeseed-mustard in India

On the inadequacy of environment impact assessments for projects in Bhagwan Mahavir Wildlife Sanctuary and National Park of Goa, India : a peer review

The Environment Impact Assessment (EIA) is a regulatory framework adopted since 1994 in India to evaluate the impact and mitigation measures of projects, however, even after 25 years of adoption, EIAs continue to be of inferior quality with respect to biodiversity documentation and assessment of impacts and their mitigation measures. This questions the credibility of the exercise, as deficient EIAs are habitually used as a basis for project clearances in ecologically sensitive and irreplaceable regions. The authors reiterate this point by analysing impact assessment documents for three projects: the doubling of the National Highway-4A, doubling of the railway-line from Castlerock to Kulem, and laying of a 400-kV transmission line through the Bhagwan Mahavir Wildlife Sanctuary and National Park in the state of Goa. Two of these projects were recently granted ‘Wildlife Clearance’ during a virtual meeting of the Standing Committee of the National Board of Wildlife (NBWL) without a thorough assessment of the project impacts. Assessment reports for the road and railway expansion were found to be deficient on multiple fronts regarding biodiversity assessment and projected impacts, whereas no impact assessment report was available in the public domain for the 400-kV transmission line project. This paper highlights the biodiversity significance of this protected area complex in the Western Ghats, and highlights the lacunae in biodiversity documentation and inadequacy of mitigation measures in assessment documents for all three diversion projects. The EIA process needs to improve substantially if India is to protect its natural resources and adhere to environmental protection policies and regulations nationally and globally

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Ureter-iliac artery graft-cutaneous fistula: A rare presentation

A 55-year-old male with a history of iliac artery – popliteal artery polytetrafluoroethylene graft bypass presented 2 years later with sudden onset gross hematuria with sepsis. Computed tomography (CT) angiography was suggestive of fistula between ureter and iliac artery which was treated with arterial covered stent graft. The patient presented 2 weeks later with watery discharge from the previous scar. CT suggested ureter-cutaneous fistula. JJ stenting of ureter was done. The patient was discharged and on follow-up CT scan, there was no evidence of fistula and patient was completely asymptomatic. Ureter-iliac artery graft fistula with cutaneous involvement has not been reported in literature before

Reprocessing and reuse of urological armamentarium: How correct are we!

Healthcare is expensive for a large proportion of the population in spite of high per capita income and good health insurance penetration. In an effort to reduce cost of the procedure, reprocessing of devices was started in the late 1970s. Reprocessing practice includes various measures such as proper cleaning, disinfection, and sterilization procedures. As reprocessing is aimed at reducing cost, there is a potential risk of compromising patient safety due to cross contamination after inadequate sterilization. There is also risk of performance alteration of urological reprocessed devices during sterilization/disinfection processing. Therefore, there is a need for formulating proper guidelines to decide methods of reprocessing for various urological equipment. There is also need to discuss the problematic areas that urologists face and to find their solutions. A PubMed search was made in September 2016, using key words “reprocessing of medical devices,” “Single Use Devices,” “methods of reprocessing of devices in clinical practice,” “use of formalin chamber,” “urological disposable sterilization,” etc., After excluding duplicates, all English articles were reviewed by title and abstract. Full texts of selected articles were obtained, and these articles were cross-referenced to find any other related articles. All the articles were reviewed. A product can be reused if it can be economically reprocessed with validated protocols with preservation of its function. There is no reason to discard it after one use. This practice is useful for controlling economics of a urological case and to reduce the financial burden. Current Food and Drug Administration guidelines are stringent. The contamination described to test the sterilization process in the suggested guidelines actually does never exist in clinical practice. Therefore, new guidelines considering the clinical practice scenario are desirable

Smart Garbage Bin – A Waste Management System

In today’s era it is very important to manage and handle the waste. The waste bins kept in the public places overflows before the garbage cleaners arrive to collect the waste. As a result, the bins are not cleared off on timely basis and foul smell, maintaining of hygiene, spread of disease are the biggest problems in the public area. Smart Dustbin is the need of the hour for the urban areas.  The paper aims at the development of a smart garbage bin alert system. The complete IoT based dustbin is designed and developed to automate the process and monitor it efficiently. The system measures the level of waste inside the bin and auto locks the garbage bin and informs municipal authorities about the same stating the location of the bin so that corrective measure can be taken for timely collection of garbage and avoidance of the filthiness in the area. The system will also adapt with network environment to manage all information from waste management

Treatment Outcome Of Seizures Associated With Intracranial Cavernous Angiomas

Seizures are among the typical presentations of intracranial cavernous angiomas (ICA). Twenty-one patients (age range: 2 to 53 years) treated for seizures associated with ICA between 1983 and 1997 were restrospectively studied to evaluate their outcome following medical or surgical intervention. The mean interval between seizure onset and initial presentation at our institution was 7.6 years. Seizures were simple partial in 3 patients, complex partial in 15 and secondarily generalized tonic-clonic in 13. The commonest site of the lesion was the temporal lobe (52%). Multiple angiomas were observed in 5 (24%) patients. Seven (32%) patients were medically-managed with antiepileptic therapy and 14 (68%) underwent either lesionectomy with resection of the epileptogenic zone (9 patients) or temporal lobectomy (5 patients). Mean follow-up time was 4 years (range: 3 months to 14 years). Of the medically-managed patients, 3 (43%) remained seizure-free whereas 4 (57%) continued to have seizures with an average frequency of one per day. Of the surgically-managed patients, 12 (86%) became seizure-free and 2 (14%) had no more than two seizures per year. Surgery appears to be extremely effective in the management of seizures associated with ICA and should receive a strong and early consideration in patients who fail medical therapy

Virulence of Native Isolates of Metarhizium anisopliae (Metschnikoff) against Helicoverpa armigera (Lepidoptera: Noctuidae) in Western Uttar Pradesh, India

The Chickpea pod borer, Helicoverpa armigera (Hubner) (Lepidoptera: Noctuidae), is a destructive pest of chickpeas that has proven difficult to control using conventional methods. We isolate and evaluate the virulence of five isolates of M. anisopliae against larvae of H. armigera. All isolates of M. anisopliae, SVPUAT 1, SVPUAT 2, SVPUAT 3, SVPUAT 4 and SVPUAT 5 were most effective against second instar, H. armigera at 2 ×108 conidia/ml. Among the all isolates, SVPUAT 1 Accession no. ON183248 had the highest virulence 100 percent mortality; whereas, LT50 and LT90 were 3.16 and 5.16 days