Induced abortion potential among Indian women

Information on abortion is limited and inaccurate especially in the developing world, which has led to several speculations on the prevalence of abortion in this region. A rise in prevalence of abortion is mostly accounted for in terms of increase in the prevalence of induced abortions, which reflects on the reproductive health of women. With the growing concern for reproductive health of women, the study of abortion phenomenon has drawn serious attention of researchers world wide. In such circumstances, this is an attempt to assess the induced abortion potential among Indian women by utilising information on proportion of unwanted and ill-timed pregnancies obtained through National Family Health Survey, India.

A successful conservative management of cervical ectopic pregnancy

Cervical ectopic pregnancy is a rare life-threatening condition with an incidence of less than 1% among all ectopic pregnancies. A 27-year-old primigravida presented with spotting per vaginum following 4 weeks 5 days of amenorrhea. Transvaginal ultrasound done at 4 weeks 5 days showed a gestational sac located in the anterior wall of cervix, diagnosis of cervical ectopic pregnancy was made. Initial serum beta hCG titre was 4106 mIU/ml. Serial monitoring of serum beta hCG done showed increasing values. Hence, decided for medical management with single dose of injection methotrexate, as the diagnosis was made at an early gestation and patient was hemodynamically stable.  On follow up, serum beta hCG did not fall significantly, hence multidose methotrexate regimen was initiated. She responded to it, but she continued to have persistent bleeding per vaginum with fall in hemoglobin levels, hence sorted for surgical management which included suction and evacuation, after ligation of descending cervical artery and subsequently cervical tamponade. Intraoperative period was uneventful. On follow-up, patient was asymptomatic and vitals stable. Serum beta hCG done 2 weeks post procedure was below 5 mIU/ml and resumed spontaneous cycles after a month. Thus, early detection and accurate diagnosis of cervical ectopic pregnancy using ultrasound and serial beta hCG titre monitoring becomes a cornerstone of management. We present this case as it was her index pregnancy, with a need to preserve future fertility, successful conservative management of Cervical ectopic pregnancy with combination of medical and surgical intervention

Hybrid Traversal: Efficient Source Code Analysis at Scale

Source code analysis at a large scale is useful for solving many software engineering problems, however, could be very expensive, thus, making its use difficult. This work proposes hybrid traversal, a technique for performing source code analysis over control flow graphs more efficiently. Analysis over a control flow graph requires traversing the graph and it can be done using several traversal strategies. Our observation is that no single traversal strategy is suitable for different analyses and different graphs. Our key insight is that using the characteristics of the analysis and the properties of the graph it is possible to select a most efficient traversal strategy for a pair. Our evaluation using a set of analyses with different characteristics and a large dataset of graphs with different properties shows up to 30% reduction in the analysis time. Further, the overhead of our technique for selecting the most efficient traversal strategy is very low; between 0.01%-0.2%

Induced abortion potential among Indian women

Information on abortion is limited and inaccurate especially in the developing world, which has led to several speculations on the prevalence of abortion in this region. A rise in prevalence of abortion is mostly accounted for in terms of increase in the prevalence of induced abortions, which reflects on the reproductive health of women. With the growing concern for reproductive health of women, the study of abortion phenomenon has drawn serious attention of researchers world wide. In such circumstances, this is an attempt to assess the induced abortion potential among Indian women by utilising information on proportion of unwanted and ill-timed pregnancies obtained through National Family Health Survey, India. This exercise may facilitate a better understanding of the exact prevalence of induced abortion which necessarily should be less than the estimated potential depending on the levels of unwanted and illtimed fertility

Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol.

BACKGROUND: Despite pre-kidney-transplant cardiovascular (CV) assessment being routine care to minimise perioperative risk, the utility of such assessment is not well established. The study reviewed the evaluation and outcome of a standardised CV assessment protocol. METHODS: Data were analysed for 231 patients (age 53.4 ± 12.9 years, diabetes 34.6%) referred for kidney transplantation between 1/2/2012-31/12/2014. One hundred forty-three patients were high-risk (age > 60 years, diabetes, CV disease, heart failure, peripheral vascular disease) and offered dobutamine stress echocardiography (DSE); 88 patients were low-risk and offered ECG and echocardiography with/without exercise treadmill test. RESULTS: At the end of follow-up (579 ± 289 days), 35 patients underwent kidney transplantation and 50 were active on the waitlist. There were 24 events (CV or death), none were perioperative. One hundred fifteen patients had DSE with proportionally more events in DSE-positive compared to DSE-negative patients (6/34 vs. 7/81, p = 0.164). In 42 patients who underwent coronary angiography due to a positive DSE or ischaemic heart disease symptoms, 13 (31%) had events, 6 were suspended, 11 removed from waitlist, 3 wait-listed, 1 transplanted and 17 still undergoing assessment. Patients with significant coronary artery disease requiring intervention had poorer event-free survival compared to those without intervention (56% vs. 83% at 2 years, p = 0.044). However, the association became non-significant after correction for CV risk factors (HR = 3.17, 95% CI 0.51-19.59, p = 0.215). CONCLUSIONS: The stratified CV risk assessment protocol using DSE in all high-risk patients was effective in identifying patients with coronary artery disease. The coronary angiograms identified the event-prone patients effectively but coronary interventions were not associated with improved survival

The three great issues confronting Europe - economic, environmental and political

Europe is confronted by an intimidating triple challenge – economic stagnation, climate change, and a governance crisis. This paper demonstrates how the three challenges are closely inter-related, and discusses how they can be dealt with more effectively in order to arrive at a more economically secure, environmentally sustainable and well governed Europe. In particular, a return to classic economic growth cannot come at the expense of greater risk of irreversible climate change. Instead, what is required is a fundamental transformation of the economy to a new ‘green’ trajectory based on rapidly diminishing emission of greenhouse gases. Following this path would mean turning Europe into a veritable laboratory for sustainable growth, environmentally as well as socially

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of spark plasma sintering and high-pressure torsion on the microstructural and mechanical properties of a Cu–SiC composite

This investigation examines the problem of homogenization in metal matrix composites (MMCs) and the methods of increasing their strength using severe plastic deformation (SPD). In this research MMCs of pure copper and silicon carbide were synthesized by spark plasma sintering (SPS) and then further processed via highpressure torsion (HPT). The microstructures in the sintered and in the deformed materials were investigated using Scanning Electron Microscopy (SEM) and Scanning Transmission Electron Microscopy (STEM). The mechanical properties were evaluated in microhardness tests and in tensile testing. The thermal conductivity of the composites was measured with the use of a laser pulse technique. Microstructural analysis revealed that HPT processing leads to an improved densification of the SPS-produced composites with significant grain refinement in the copper matrix and with fragmentation of the SiC particles and their homogeneous distribution in the copper matrix. The HPT processing of Cu and the Cu-SiC samples enhanced their mechanical properties at the expense of limiting their plasticity. Processing by HPT also had a major influence on the thermal conductivity of materials. It is demonstrated that the deformed samples exhibit higher thermal conductivity than the initial coarse-grained samples

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS