Serum uric acid as marker of severity of pre-eclampsia

Background: In pre-eclampsia, there is increased uteroplacental resistance and reduced foetal perfusion due to inadequate invasion of spiral arterioles by trophoblast cells. This causes impaired foetal growth and foetal hypoxia. To assess the usefulness of foetal Doppler in predicting adverse perinatal outcome in preeclampsia.Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio >2 standard deviation (SD) or UA - Pulsatility Index (PI) and UA - Resistive Index (RI) >2 SD were taken as abnormal. The middle cerebral artery (MCA) was visualised and cerebroumblical PI ratio calculated. MCA-RI 2SD (RR 4.46, 95%, CI 1.40-14.17) and RI >2SD (RR 3.36, 95%, CI 1.03-10.61) and MCA RI 2SD predicted acute foetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.Conclusions: This study showed UA-S/D ratio and UA-RI >2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute foetal distress in labour or neonatal nursery admission could not be predicted

An isogeometric finite element formulation for phase transitions on deforming surfaces

This paper presents a general theory and isogeometric finite element implementation for studying mass conserving phase transitions on deforming surfaces. The mathematical problem is governed by two coupled fourth-order nonlinear partial differential equations (PDEs) that live on an evolving two-dimensional manifold. For the phase transitions, the PDE is the Cahn-Hilliard equation for curved surfaces, which can be derived from surface mass balance in the framework of irreversible thermodynamics. For the surface deformation, the PDE is the (vector-valued) Kirchhoff-Love thin shell equation. Both PDEs can be efficiently discretized using $C^1$-continuous interpolations without derivative degrees-of-freedom (dofs). Structured NURBS and unstructured spline spaces with pointwise $C^1$-continuity are utilized for these interpolations. The resulting finite element formulation is discretized in time by the generalized-$\alpha$ scheme with adaptive time-stepping, and it is fully linearized within a monolithic Newton-Raphson approach. A curvilinear surface parameterization is used throughout the formulation to admit general surface shapes and deformations. The behavior of the coupled system is illustrated by several numerical examples exhibiting phase transitions on deforming spheres, tori and double-tori.Comment: fixed typos, extended literature review, added clarifying notes to the text, added supplementary movie file

A Tchebycheffian extension of multi-degree B-splines: Algorithmic computation and properties

In this paper we present an efficient and robust approach to compute a normalized B-spline-like basis for spline spaces with pieces drawn from extended Tchebycheff spaces. The extended Tchebycheff spaces and their dimensions are allowed to change from interval to interval. The approach works by constructing a matrix that maps a generalized Bernstein-like basis to the B-spline-like basis of interest. The B-spline-like basis shares many characterizing properties with classical univariate B-splines and may easily be incorporated in existing spline codes. This may contribute to the full exploitation of Tchebycheffian splines in applications, freeing them from the restricted role of an elegant theoretical extension of polynomial splines. Numerical examples are provided that illustrate the procedure described

Evaluation of percutaneous pinning in fracture proximal one-third humerus and fracture dislocation

Background: Proximal humerus fracture treatment is still an issue with lot of controversies and various treatment modalities had yielded mixed results. Our aim is to study percutaneous K-wires fixation as a modality of treatment, does not need extensive soft tissue dissection, so small fracture fragments & retains periosteal muscle & ligament attachments which held the fracture fragments together. Complications of open reduction are avoided.Methods: Fractures were classified according to Neer’s Classification system and were treated with closed reduction and K-wire Fixation. They were 16 males and 09 females, with a mean age of 40.5 years. Mean follow-up was of 20.5 months (range 9-24 months). Post-operative mean VAS score and Constant Score of patients was 2.1 (±0.73) and 78.1 (±9.61) at an average follow up of 6 months. Mean duration for union was 6.5 (±1.18) weeks. Patients were followed up at 4, 8, 12 weeks and 3, 6, 9 & 12 months interval.Results: Radiological and functional outcome assessed according to Constant-Murley Shoulder assessment. Complications treated accordingly. Percutaneous K-wire fixation is safe, limited invasive technique and following basic principles of anatomical reduction has excellent results & functional outcome.Conclusions: We concluded that the soft-tissue bridging of the fracture fragments was crucial for the reduction to benefit from the ligamentotaxis effect. This technique worked well for valgus-impacted or three-part fractures. The rate of osteonecrosis was low, and rehabilitation was easier. Overall, the results from these series are quite encouraging

Sputum Smear Microscopy at Two Months into Continuation-Phase: Should It Be Done in All Patients with Sputum Smear-Positive Tuberculosis?

BACKGROUND: The Revised National Tuberculosis Control Program (RNTCP) of India recommends follow-up sputum smear examination at two months into the continuation phase of treatment. The main intent of this (mid-CP) follow-up is to detect patients not responding to treatment around two-three months earlier than at the end of the treatment. However, the utility of mid-CP follow-up under programmatic conditions has been questioned. We undertook a multi-district study to determine if mid-CP follow-up is able to detect cases of treatment failures early among all types of patients with sputum smear-positive TB. METHODOLOGY: We reviewed existing records of patients with sputum smear-positive TB registered under the RNTCP in 43 districts across three states of India during a three month period in 2009. We estimated proportions of patients that could be detected as a case of treatment failure early, and assessed the impact of various policy options on laboratory workload and number needed to test to detect one case of treatment failure early. RESULTS: Of 10055 cases, mid-CP follow-up was done in 6944 (69%) cases. Mid-CP follow-up could benefit 117/8015 (1.5%) new and 206/2040 (10%) previously-treated sputum smear-positive cases by detecting their treatment failure early. Under the current policy, 31 patients had to be tested to detect one case of treatment failure early. All cases of treatment failure would still be detected early if mid-CP follow-up were discontinued for new sputum smear-positive cases who become sputum smear-negative after the intensive-phase of treatment. This would reduce the related laboratory workload by 69% and only 10 patients would need to be tested to detect one case of treatment failure early. CONCLUSION: Discontinuation of mid-CP follow-up among new sputum smear-positive cases who become sputum smear-negative after completing the intensive-phase of treatment will reduce the laboratory workload without impacting overall early detection of cases of treatment failure

Costs of TB services in India (No 1).

BACKGROUND: There is a dearth of economic analysis required to support increased investment in TB in India. This study estimates the costs of TB services from a health systems´ perspective to facilitate the efficient allocation of resources by India´s National Tuberculosis Elimination Programme.METHODS: Data were collected from a multi-stage, stratified random sample of 20 facilities delivering TB services in two purposively selected states in India as per Global Health Cost Consortium standards and using Value TB Data Collection Tool. Unit costs were estimated using the top-down (TD) and bottom-up (BU) methodology and are reported in 2018 US dollars.RESULTS: Cost of delivering 50 types of TB services and four interventions varied according to costing method. Key services included sputum smear microscopy, Xpert® MTB/RIF and X-ray with an average BU costs of respectively US$2.45, US$17.36 and US$2.85. Average BU cost for bacille Calmette-Guérin vaccination, passive case-finding, TB prevention in children under 5 years using isoniazid and first-line drug treatment in new pulmonary and extrapulmonary TB cases was respectively US$0.76, US$1.62, US$2.41, US$103 and US$98.CONCLUSION: The unit cost of TB services and outputs are now available to support investment decisions, as diagnosis algorithms are reviewed and prevention or treatment for TB are expanded or updated in India