HELLP syndrome, associated with eclampsia, preeclampsia, in one hundred cases, the complications, maternal morbidity and mortality: the near miss and missed obstetric scenarios

Background: The investigations done, complications observed, mode of delivery, management of complications, the perinatal outcome, the maternal mortality, the lessons learnt have been outlined. The referral to higher tertiary care Institutes has been analysed. The goals of management were, control of hypertension, prevention of convulsions, assessment of the severity of HELLP syndrome, identification of associated complications and chances of fetal salvage, a decision to be made regarding the mode of delivery, keeping the blood products ready, anaesthetist and paediatrician to be informed, consultation of nephrologist, cardiologist, neurophysician, ophthalmologist, gastroenterologist, surgeon as required in the particular case and continued vigilance in the postpartum period. Methods: This is a prospective observational study of one hundred cases of HELLP syndrome managed at two tertiary care Institutes. Twenty-five cases, managed at CARE Institute of Medical sciences, during the years 2011 to 2013 and 75 cases from the Institute of Obstetrics and Gynaecology at Modern Government Maternity Hospital, MGMH, Osmania Medical College, OMC, between 2021 to 2023, were included in the study. Results: Labour was induced, in 47.29%, vaginal delivery in 28 cases, 37.83% and lower segment caesarean section (LSCS) was needed in 46, 62.16% in the study. A total of 90.66% of HELLP have occurred in the third trimester of pregnancy. Eclampsia was associated with HELLP syndrome in 39/100=39%. The remaining 61 cases had preeclampsia associated HELLP syndrome. PRAKI in 31/100=31%, DIC in 19%, PRES in 7/100, PPCM 2%, PPH in 18=24%, maternal mortality in 17/100=17%. Conclusions: Delivery by 37 weeks would have clearly prevented 36% of cases. Delivery by 35 weeks would have prevented 61% of cases of HELLP syndrome

Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Background: It is well-known since long time the beneficial effects of misoprostol particularly as a cervical softening agent in obstetric practice. Keep in view, study aimed to evaluate the efficacy of vaginal misoprostol 400 mcg before endometrial biopsy in premenopausal women.Methods: All the 200 patients were classified into two groups viz. study group (Group I) with 100 patients and control group (Group II) with 100 patients. To Group I patients, 400 mcg of misoprostol was given vaginally, 4 hours prior to the commencement of endometrial biopsy whereas no medication was received by Group II patients.Results: In the present study, the base line cervical dilatation is found to be 5.8±1.3 mm in Group I patients whereas 3.8±0.92 mm in Group II patients which is significantly higher (p<0.05). Only 32 patients in Group I required further dilatation whereas 88 patients in Group II underwent further dilatation. The mean time required for further dilatation in Group I and Group II patients was 42.6±17.4, 64.6±16.8 sec respectively and was significantly higher in Group II patients (p<0.05). Out of 100 patients in Group I, only 2% of patients complained severe pain whereas in Group II 48% of patients experienced intolerable pain and required anesthesia.Conclusions: Vaginal administration of 400 mcg misoprostol 4 hours prior to endometrial biopsy in premenopausal women had a significant effect on cervical resistance and cervical dilatation

A comparative evaluation of properties of denture base materials processed with different processing methods: a preliminary study.

Background: The use of the traditional polymerization process of dentures necessitates a lot of time and energy. To depreciate these factors, a different processing method could be studied. Aim: This study was aimed to evaluate and compare the properties of denture base resin material processed with conventional curing and pressure-pot method. Materials and methods: A total of 30 specimens with distinct dimensions were fabricated with the denture base materials. The specimens were divided into two groups with 15 each, and they were processed using conventional heat-curing and pressure-pot processing, respectively. Each group is subdivided into three groups with five specimens in each for evaluating flexural strength, water sorption, and residual monomer, respectively. Flexural strength was measured using a 3-point bending test with a Universal testing machine. Water sorption was assessed by measuring the weight of the specimens after immersing them in distilled water. Residual monomer content was evaluated using a UV spectrophotometer.  The obtained data were statistically analysed using an independent t-test. Results: A slight increase in flexural strength was observed in the pressure processed specimens. However, no significant differences (p=0.131) were observed in the flexural strength between the groups. Less water sorption percentage was observed with the pressure processed acrylic resin specimens, and a significant difference (p=0.047) was observed between the groups. A slightly more amount of residual monomer content was seen in the acrylic specimens processed conventionally. Conclusion: Pressure-pot curing may be used for processing denture base acrylics as it provides properties similar to that of the conventional curing method

Sixteen years of social and ecological dynamics reveal challenges and opportunities for adaptive management in sustaining the commons

Efforts to confront the challenges of environmental change and uncertainty include attempts to adaptively manage social–ecological systems. However, critical questions remain about whether adaptive management can lead to sustainable outcomes for both ecosystems and society. Here, we make a contribution to these efforts by presenting a 16-y analysis of ecological outcomes and perceived livelihood impacts from adaptive coral reef management in Papua New Guinea. The adaptive management system we studied was a customary rotational fisheries closure system (akin to fallow agriculture), which helped to increase the biomass of reef fish and make fish less wary (more catchable) relative to openly fished areas. However, over time the amount of fish in openly fished reefs slowly declined. We found that, overall, resource users tended to have positive perceptions about this system, but there were negative perceptions when fishing was being prohibited. We also highlight some of the key traits of this adaptive management system, including 1) strong social cohesion, whereby leaders played a critical role in knowledge exchange; 2) high levels of compliance, which was facilitated via a “carrot-and-stick” approach that publicly rewarded good behavior and punished deviant behavior; and 3) high levels of participation by community actors

Potential impacts of climate change on agriculture and fisheries production in 72 tropical coastal communities

Climate change is expected to profoundly affect key food production sectors, including fisheries and agriculture. However, the potential impacts of climate change on these sectors are rarely considered jointly, especially below national scales, which can mask substantial variability in how communities will be affected. Here, we combine socioeconomic surveys of 3,008 households and intersectoral multi-model simulation outputs to conduct a sub-national analysis of the potential impacts of climate change on fisheries and agriculture in 72 coastal communities across five Indo-Pacific countries (Indonesia, Madagascar, Papua New Guinea, Philippines, and Tanzania). Our study reveals three key findings: First, overall potential losses to fisheries are higher than potential losses to agriculture. Second, while most locations (> 2/3) will experience potential losses to both fisheries and agriculture simultaneously, climate change mitigation could reduce the proportion of places facing that double burden. Third, potential impacts are more likely in communities with lower socioeconomic status

Seroprevalence and risk factors of herpes simplex virus type-2 infection among pregnant women in Northeast India

<p>Abstract</p> <p>Background</p> <p>Herpes simplex virus type-2 (HSV-2) is one of the most common sexually transmitted infections that facilitate human immunodeficiency virus (HIV) acquisition by over two fold or more. The development of HSV-2 control methods as a measure to control HIV epidemic in high HSV-2/HIV areas has become a priority. Two out of the six high HIV prevalent states of India are located in the Northeastern region of India. Due to lack of documented HSV-2 studies from this part of the country; there was a need for estimating the seroprevalence and risk factors of HSV-2 infection in this defined population.</p> <p>Methods</p> <p>Pregnant women (n = 1640) aged18 years and above attending antenatal clinics of tertiary referral hospitals in five Northeastern states of India were screened for type specific HSV-2 IgG antibodies. Blood samples were collected from all the participants after conducting interviews. Univariate and multivariate analyses were performed to identify the risk factors associated with HSV-2 seropositivity.</p> <p>Results</p> <p>Overall seroprevalence of HSV-2 infection was 8.7% (142/1640; 95% CI 7.3-10.0) with a highest prevalence of 15.0% (46/307; 95% CI 11.0-19.0) in the state of Arunachal Pradesh. Higher seroprevalence was observed with increasing age (Adj. Odds Ratio [AOR] 1.9 for 22-25 years old, AOR 2.29 for > 29 years old). The risk factors associated with HSV-2 seropositives were multiple sex partners (AOR 2.5, <it>p </it>= 0.04), condom non-user's (AOR 4.7, p <it><</it>0.001), early coitarchal age (age of first intercourse) 'less than 18 years' (AOR 9.6, <it>p = </it>0.04), middle income group (AOR 2.1, <it>p = </it>0.001) compared to low income group and low level of education (AOR 3.7, <it>p = </it>0.02) compared to higher education. HSV-2 seropositivity was higher among Christians (12.6%) compared to Muslims (3.8%). The most frequent clinical symptoms among HSV-2 seropositives were excess vaginal discharge in last one year (53.5%, 76/142) and pelvic pain (26.1%, 37/142). While among subjects with genital ulcers, HSV-2 seroprevalence was 36.8% (7/19).</p> <p>Conclusions</p> <p>Overall seroprevalence of HSV-2 infection among pregnant women of Northeast India is relatively low. The generation of awareness among high risk groups may have played key role to limit the infection. The role of vaccination against HSV-2 in near future and elimination of HSV-2 viral shedding along with genital tract inflammation in high HIV/HSV-2 areas may be an option for initiating successful intervention strategies to reduce the transmission and acquisition of HIV infection in Northeast India.</p

<i>Mycobacterium tuberculosis</i> Central Metabolism Is Key Regulator of Macrophage Pyroptosis and Host Immunity

Metabolic dysregulation in Mycobacterium tuberculosis results in increased macrophage apoptosis or pyroptosis. However, mechanistic links between Mycobacterium virulence and bacterial metabolic plasticity remain ill defined. In this study, we screened random transposon insertions of M. bovis BCG to identify mutants that induce pyroptotic death of the infected macrophage. Analysis of the transposon insertion sites identified a panel of fdr (functioning death repressor) genes, which were shown in some cases to encode functions central to Mycobacterium metabolism. In-depth studies of one fdr gene, fdr8 (BCG3787/Rv3727), demonstrated its important role in the maintenance of M. tuberculosis and M. bovis BCG redox balance in reductive stress conditions in the host. Our studies expand the subset of known Mycobacterium genes linking bacterial metabolic plasticity to virulence and also reveal that the broad induction of pyroptosis by an intracellular bacterial pathogen is linked to enhanced cellular immunity in vivo