Comparative study of oral PGE 1 and intracervical PGE2 gel for pre-induction cervical ripening in prelabour rupture of membranes >37 weeks gestational age

Background: Active induction of labour in prelabour rupture of membranes resulted in a lower risk of maternal and fetal sepsis as compared to conservative management. Pre-induction cervical ripening helps in successful induction of labour.in this study we have compared the efficacy of low dose 25 mcg oral misoprostol versus intracervical PGE2 gel for cervical ripening in term PROM patients.Methods: Women with pregnancies between 37 and 41 weeks gestational age presenting with PROM at term and a Bishop score of 4 or less were randomly assigned to receive either a 25-mcg oral misoprostol every 4-hourly interval or 3 applications of intracervical PGE2 gel at a 6-hour interval for effective cervical ripening. Oxytocin was initiated if labor had not started after 6 hours of last effective dose of prostaglandin.Results: Fifty-three women (75.73%) (n = 70) in the oral misoprostol group with 2 doses, 4 hours apart had successful cervical ripening within 8 hours in comparison to sixty-two women (88.58%) (n = 70) in the intracervical PGE2 gel group with 2 doses, 6 hrs apart approximately 12 hrs for successful ripening. (p = 0.021). Oral misoprostol group needed shorter mean duration interval for the Bishop score 6 than intracervical PGE2 gel group, 7.84±3.64 hours and 9.39±4.20 hours respectively (p = 0.022). Similarly, the mean time duration interval from ruptured membranes to vaginal delivery in oral misoprostol was shorter i.e. 12.60±3.78 hours versus 14.66±4.08 hours (p = 0.005).Conclusions: Low dose 25 mcg oral misoprostol is a safe, efficacious and better tolerated alternative to intracervical PGE2 gel for pre-induction cervical ripening in especially in PROM patients at term

Influence of Process Parameters and Responses on Performance of CNC Machine Turning Operation by using Multiple Regression Method

Influence of process parameters and responses on performance of CNC machine turning operation on EN-31 steel material in turning operations. This study aims at determining the factors and their interaction that may affect the responses. The response such as surface finish is greatly influenced by factors such as speed, feed rate and depth of cut. Multiple regression method is used to analyze the performance of process parameter on response such as surface finish rate is done on CNC lathe on EN31 sample. Hence, multiple regression model for surface finish has been developed, as a function of spindle speed, feed rate and depth of cut.. It was concluded that surface finish is highly dependent on spindle speed. DOI: 10.17762/ijritcc2321-8169.150518

Management of elderly patients with troponin positive chest pain in a District General Hospital

Background: The number of elderly patients that present with an acute coronary syndrome (ACS) is increasing, reflecting the growing number of people in the general population in this age group. The various guidelines do not generally specify a management strategy in this elderly group and the management is often at the discretion of the treating physician. We conducted an audit within our Cardiology Department to compare our practice of management of ACS in the elderly population based on the European Society of Cardiology guidelines. Methods: We conducted a retrospective analysis of the management of patients aged 80 and above that were admitted with troponin positive chest pain from 1st January to 31st December 2010. Patient information was primarily obtained from our computer data base system that includes blood results, ECHOs, diagnostic angiograms, discharge and clinic letters. If the information was inadequate we obtained patient files or contacted the relevant general practitioner. Results: Octo-nonagenarians represented just over a third (35%) of all patients that were admitted with a troponin positive event during the study period. We noted a 10% mortality rate observed in our study population over a 12 month period. Atrial fibrillation was an incidental finding in 22% of patients. Nearly half of these patients (49%) were managed by the cardiologists. 68% of these patients underwent diagnostic coronary angiography, of which 32% went on to have percutaneous coronary intervention and 7% underwent surgical intervention. Majority (80%) of patients that underwent angioplasty had more than 1 stent and 74% of patients required more than one coronary vessel to be stented. The length of stay in hospital was double for patients who were under the care of the general medical teams rather than the cardiology team. This group also had a higher number of other comorbidities such as dementia, malignancy, a history of gastro intestinal bleeds and chronic renal impairment. Conclusions: Octo and nonagenarians represent a significant proportion of our ACS patients. They have high mortality, greater number of comorbidities, diseased coronary vessels and if intervention was undertaken required more than one stent. Therefore, octo-nonagenarians represent a very complex group of patients. Guidelines and risk stratification are of limited value in this group as clinical trial data is currently lacking. Quality of life and risk to benefit assessments are of paramount importance in this group

Sumoylation is tumor-suppressive and confers proliferative quiescence to hematopoietic progenitors in Drosophila melanogaster larvae

Summary How cell-intrinsic regulation of the cell cycle and the extrinsic influence of the niche converge to provide proliferative quiescence, safeguard tissue integrity, and provide avenues to stop stem cells from giving rise to tumors is a major challenge in gene therapy and tissue engineering. We explore this question in sumoylation-deficient mutants of Drosophila. In wild type third instar larval lymph glands, a group of hematopoietic stem/progenitor cells acquires quiescence; a multicellular niche supports their undifferentiated state. However, how proliferative quiescence is instilled in this population is not understood. We show that Ubc9 protein is nuclear in this population. Loss of the SUMO-activating E1 enzyme, Aos1/Uba2, the conjugating E2 enzyme, Ubc9, or the E3 SUMO ligase, PIAS, results in a failure of progenitors to quiesce; progenitors become hyperplastic, misdifferentiate, and develop into microtumors that eventually detach from the dorsal vessel. Significantly, dysplasia and lethality of Ubc9 mutants are rescued when Ubc9wt is provided specifically in the progenitor populations, but not when it is provided in the niche or in the differentiated cortex. While normal progenitors express high levels of the Drosophila cyclin-dependent kinase inhibitor p21 homolog, Dacapo, the corresponding overgrown mutant population exhibits a marked reduction in Dacapo. Forced expression of either Dacapo or human p21 in progenitors shrinks this population. The selective expression of either protein in mutant progenitor cells, but not in other hematopoietic populations, limits overgrowth, blocks tumorogenesis, and restores organ integrity. We discuss an essential and complex role for sumoylation in preserving the hematopoietic progenitor states for stress response and in the context of normal development of the fly

Men in the Remaking: Conversion Narratives and Born-Again Masculinity in Zambia

The born-again discourse is a central characteristic of Pentecostal Christianity in Africa. In the study of African Christianities, this discourse and the way it (re)shapes people’s moral, religious, and social identities has received much attention. However, hardly any attention has been paid to its effects on men as gendered beings. In the study of men and masculinities in Africa, on the other hand, neither religion in general nor born-again Christianity in particular are taken into account as relevant factors in the construction of masculinities. On the basis of a detailed analysis of interviews with men who are members of a Pentecostal church in Lusaka, Zambia, this article investigates how men’s gender identities are reshaped by becoming and being born-again and how born-again conversion produces new forms of masculinity. The observed Pentecostal transformation of masculinity is interpreted in relation to men’s social vulnerability, particularly in the context of the HIV epidemic in Zambia

Monitoring of biomarkers in heart failure.

The role of biomarkers is increasingly recognized in heart failure (HF) management, for diagnosis, prognostication, and screening of high-risk patients. Beyond natriuretic peptides and troponins, the utility of novel, emerging biomarkers is less established. This document reflects the key points of a Heart Failure Association of the European Society of Cardiology (ESC) consensus meeting on biomarker monitoring in HF