Preterm premature rupture of membranes: correlates and pregnancy outcome in a tertiary care setting

Background: Prelabour membrane rupture before 37 weeks of gestation is referred to as preterm premature rupture of membranes (PPROM). Incidence of PPROM is about 2% of all pregnancies. This prospective study aims to determine fetal and early neonatal outcome of pregnancies with PPROM.Methods: The study was conducted in 190 antenatal women with PPROM between 24 weeks to 36weeks of gestation over a period of 18 months. Their babies were followed up till discharge from Pediatric new born unit.                              Results: Prevalence of PPROM was 0.8%, accounting for 19% of preterm deliveries. 61% of women with PPROM showed evidence of lower genito-urinary tract infection, 28% had anemia, 48% gave history of coitus during pregnancy. Mean gestational age of membrane rupture was 32 weeks, the mean latency between membrane rupture and delivery was 4.4 days. Chorioamnionitis developed in 13% of women with PPROM, cord prolapse in 4% and abruption in 3%. The gestational age wise survival was 40% in babies weighing less than 1.5kg, 88% in babies weighing 1.5 to 2.5kg and 93% in those more than 2.5kg. The predominant causes of neonatal mortality were hyaline membrane disease (HMD) in babies born before 28 weeks, HMD and sepsis between 29 to 33 weeks and sepsis in babies born after 34 weeks.Conclusions: Screening and treatment of risk factors may contribute to prevention of PPROM. Neonatal survival depends on gestational age and availability of advanced NICU facilities. Patients and family members should be counseled regarding the outcome of pregnancies with PPROM. A team effort by the obstetrician and neonatologist in a tertiary care setting can ensure a healthy and fruitful life for mother and baby.

Neomercantilism and great-power energy competition in Central Asia and the Caspian.

The neomercantilist energy policies of China and Russia contribute to what is largely a competitive relationship among all three great powers in Central Asia. While neomercantilist policies do not negate the possibility of cooperation and the development of norms, rules, and institutions designed to promote collective action, they certainly erect formidable barriers

Teaching Corner-“Lumps and Bumps”: A practical guide to minor surgery for the Core Surgical Trainee

The first local anaesthetic operating list faced by a Core Surgical Trainee (CT) can appear a daunting task. Fresh from Foundation Year (FY) posts, (s)he will lack experience in basic surgical techniques. At present, there is no formal training in minor surgical skills for FY doctors, and exposure to operative surgery can be variable. This review provides an introduction and practical guide to the operative management of minor surgical pathologies

A comparative study of socio demographic profile, clinical profile and maternal outcome of caesarian section done in second stage of labour with elective caesarean section

Background: Today caesarean section is one of the most commonly performed surgical procedures. But caesarean section is associated with a great deal of maternal and fetal morbidity and mortality. In general unplanned or emergency caesarean section has increased risk than elective caesarean section. Objectives of the study were to compare the socio demographic and clinical profile of antenatal women undergoing caesarian section in second stage of labour with elective caesarian section and to compare the maternal outcomes (morbidity and mortality) when caesarian section is done in second stage of labour with elective caesarean section.Methods: This was a comparative study done at a tertiary care centre in south Kerala for a period of 18 months which compared two groups. Group 1 which included pregnant women who required emergency caesarean section during second stage of labour and group 2 including pregnant women who required elective caesarean. Demographic and clinical profile collected. Sample size was 145 each from both groups with total of 290.Results: Intra operative complications (31% versus 17.9%), febrile morbidity (15% versus 10%), urinary retention (2.1% versus nil) PPH (2.8% versus 0.7%), post op infections (19.3% versus 9.7%), Blood transfusions (13% versus 0.4%) were significantly more with emergency caesarean sections done in second stage of labour. However increased maternal risks associated with unplanned caesarean sections do not in general justify, elective caesarean to avoid the risks of emergency surgery.Conclusions: It is concluded that postoperative morbidity are more with emergency caesarean done at full cervical dilatation. The commonest one being febrile morbidity and then urinary retention

NATO enlargement and US grand strategy: a net assessment

NATO did not dissolve following the Soviet Union’s collapse and the end of the Cold War. Instead, the alliance expanded, in stages—from 16 members at its Cold War peak to 30 in 2020. While NATO enlargement alone did not cause the deterioration of US–Russian relations, it did contribute significantly to that outcome. Champions of NATO expansion aver that it maintains peace in Europe and promotes democracy in East-Central Europe. They add that Russia has nothing to fear. But Russia’s leaders have always seen NATO expansion differently. The article also examines NATO’s enlargement as it relates to US post-Cold War grand strategy. It contends the policy reflects the abiding US commitment to maintaining its global primacy, which, in part, is ensured by perpetuating Europe’s dependence on the USA for an elemental need: security. We conclude by considering the future of NATO and Europe

Metabolism of high-density lipoproteins in cultured rat luteal cells

The uptake of cholesterol from high-density lipoproteins (HDL) labeled with 125I and [3H]cholesterol was examined in cultured rat luteal cells. Luteal cells were incubated with labeled HDL, following which the metabolic fate of the apolipoproteins and cholesterol moieties of the receptor-bound HDL were examined. About 50% of the originally bound HDL apolipoproteins were released into the medium in 24 h by a temperature-dependent process while only 5% of the HDL cholesterol was released unmetabolized. Inclusion of unlabeled HDL in the chase incubation resulted in increased release of apolipoprotein-derived radioactive products without significant change in the release of unmetabolized cholesterol. 60% of the apolipoproteinderived radioactivity could be precipitated with trichloroacetic acid; the remaining trichloroacetic acid-soluble radioactive fraction was identified as [125I] iodotyrosine. Gel filtration chromatography of the chase-released material showed that the trichloroacetic acid-precipitable products, which contained no detectable amounts of cholesterol, eluted over a range of molecular sizes (9-80 kDa). No intact HDL was retroendocytosed. About 80% of trichloroacetic acid-precipitable products could be immunoadsorbed on antiapolipoprotein A-I antibody immobilized on CNBr-activated Sepharose, suggesting the presence of fragments containing apolipoprotein A-I. This material was also capable of reassociating with native HDL. Lysosomal inhibitors were partially effective in inhibiting the amount of trichloroacetic acid-soluble products formed. The lysosomal degradation appeared to have no role in the uptake of HDL-derived cholesterol. These studies demonstrate preferential and total uptake of HDL cholesterol by luteal cells, with concomitant degradation of the lipoprotein.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26580/1/0000119.pd

Differential uptake and metabolism of free and esterified cholesterol from high-density lipoproteins in the ovary

Rat luteal cells utilize high-density lipoproteins (HDL) as a source of cholesterol for steroid synthesis. Both the free and esterified cholesterol of HDL are utilized by these cells. In this report, we have examined the relative uptake of free and esterified cholesterol of HDL by cultured rat luteal cells. Incubation of the cells with HDL labeled with [3H]cholesterol or [3H]cholesteryl linoleate resulted in 4-6-fold greater uptake of the free cholesterol compared to esterified cholesterol. The increased uptake of free cholesterol correlated with its utilization for progestin synthesis: utilization of HDL-derived free cholesterol was 3-6-fold higher than would be expected from its concentration in HDL. The differential uptake and utilization of free and esterified cholesterol was further examined using egg phosphatidylcholine liposomes containing cholesterol or cholesteryl linoleate as a probe. Liposomes containing free cholesterol were able to deliver cholesterol to luteal cells and support steroid synthesis in the absence of apolipoproteins, and the addition of apolipoprotein A-I (apo A-I) moderately increased the uptake and Steroidogenesis. Similar experiments using cholesteryl linoleate /egg phosphatidylcholine liposomes showed that inclusion of apo A-I resulted in a pronounced increase in the uptake of cholesteryl linoleate and progestin synthesis. These experiments suggest that free cholesterol from HDL may be taken up by receptor-dependent and receptor-independent processes, whereas esterified cholesterol uptake requires a receptor-dependent process mediated by apolipoproteins.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27333/1/0000358.pd

IN SILICO DESIGN, SYNTHESIS, CHARACTERIZATION, IN VITRO ANTI-INFLAMMATORY, AND ANTIOXIDANT STUDIES OF 4-ARYL-4H-CHROMENE DERIVATIVES

Objective: The objective of the study was to explore in silico design, preparation, characterization, and evaluation in vitro of some novel 4H-chromene derivatives as anti-inflammatory and antioxidant agents.Methods: 4-phenyl-4H chromene derivatives were imperiled to in silico modeling studies at the molecular level. The ligands were docked against cyclooxygenase-2 (COX-2) receptor targets using Argus Lab. Based on the result, the derivatives were selected for wet lab synthesis. A highly efficient multicomponent reaction of 4H chromene was carried out by one-step condensation of aldehyde with malononitrile and resorcinol without catalyst in water under ultrasound irradiation. The prepared compounds were characterized by noting their melting point, ultraviolet (UV) spectroscopy, infrared (IR) spectroscopy, and thin layer chromatography (TLC) and were scrutinized for its in vitro anti-inflammatory and antioxidant activitives by in vitro cell culture studies. IR spectra of the two compounds were analyzed and studied. Thus, using melting point, TLC and UV spectroscopy the synthesized compounds were found to be pure and identified chemically. The synthesized compounds were then screened for in vitro antioxidant (by 2,2-diphenyl-1-picrylhydrazyl (DPPH) and hydrogen peroxide free radical scavenging) activity and anti-inflammatory activity by Raw 264.7 cell lines.Result: From the study, it was noticed that chemical structure-2 showed better antioxidant and anti-inflammatory activitives than chemical structure. In the 4-phenyl-4H chromene derivatives, hydroxyl substitution at 7th position and electronegative halogen at 4th position showed better antioxidant and anti-inflammatory activities.Conclusion: The results disclosed that these synthesized derivatives be likely to have moderate action against COX-2 mediated diseases, thereby it may lessen inflammation and agony because of its antioxidant and anti-inflammatory activitives

A comparison of clinical outcomes between vaccinated and vaccine-naive patients of COVID-19, in four tertiary care hospitals of Kerala, South India

The problem considered: This multi-centric study analyzed data of COVID-19 patients and compared differences in symptomatology, management, and outcomes between vaccinated and vaccine-naive patients. Methods: All COVID-19 positive individuals treated as an in-or out-patient from the 1stMarch to 15th May 2021 in four selected study sites were considered for the study. Treatment details, symptoms, and clinical course were obtained from hospital records. Chi-square was used to test the association of socio-demographic and treatment variables with the vaccination status and binary logistic regression were used to obtain the odds ratio with a 95% confidence interval. Results: The analysis was of 1446 patients after exclusion of 156 with missing data of which males were 57.3% and females 42.7%. 346 were vaccinated; 189 received one dose and 157 both doses. Hospitalization was more in vaccinated (38.2% vs 27.4%); ICU admissions were less in vaccinated (3.5% vs 7.1%). More vaccinated were symptomatic (OR = 1.5); half less likely to be on non-invasive ventilation (OR = 0.5) while vaccine naive patients had 4.21 times the risk of death. Conclusion: Severe infection, duration of hospital stays, need for ventilation and death were significantly less among vaccinated when compared with vaccine naive patients