Annotations of Connectives and Arguments in Malayalam Language

AbstractDiscourse relations in natural languages link clauses in text and compose overall text structure. Discourse connectives are an important part of modeling the Malayalam discourse structure. We followed the annotation procedure of Penn Discourse Tree Bank and worked on tagging of discourse connectives and arguments of Malayalam text and also report the senses of relation. We present our work on annotations of Malayalam discourse connectives and arguments which helps to know more about the discourse connectives and their appearance in case of semantic rules in Malayalam discourse. Discourse connectives may or may not be explicitly present in the relation. In our work, we focus on the annotation of both explicit and implicit connectives and arguments in Malayalam text and showed encouraging results

A case of post dural puncture headache following labour epidural analgesia, managed by sphenopalatine ganglion block

Postpartum headache is a common complaint faced by most obstetricians, with over 39% of women having headache in the first postpartum week. With the increasing use of labour epidural analgesia, the incidence of postdural puncture headache (PDPH) due to inadvertent dural puncture is 0.5-1%. Most treatment modalities relieve the symptoms of PDPH by minimizing compensatory cerebral vasodilatation, or by sealing the dural puncture site. Treatment options include, conservative, pharmacological, and the gold standard, epidural blood patch (EBP). EBP is invasive and may result in rare however, severe complications. Sphenopalatine ganglion block (SPGB) has been proposed as a non-invasive intervention for PDPH, which has minimal adverse effects, which can be performed bedside. Here we are reporting a case of PDPH, following labour epidural analgesia which was effectively managed by a sphenopalatine block.

Study of placental location and pregnancy outcome

Background: Placental location can be estimated easily using ultrasonogram by 16 weeks. It can be classified based on its location into central and lateral. Central can be anterior or posterior. Lateral can be left lateral or right lateral. Placental location has been attributed to both normal and abnormal pregnancy and neonatal outcomes.Methods: This is a prospective cohort study conducted in the department of Obstetrics and Gynecology which comprised of 450 singleton gestations between 18 and 24 weeks. The primary objective is to determine the association between placental location and pregnancy outcome and secondary objective is to find out the association between placental location and neonatal outcome. The study population was divided into two groups – central and lateral. Results were analyzed using SPSS version 20, Chi square test and independent two sample t-test.Results: The frequency of central placenta was 377 (83.8%) and lateral placenta in 73 (16.2%). Central placentation had an abnormal outcome in 182(48.3%), lateral placentas with abnormal outcome were 44(60.3%). Abnormal maternal outcomes like hypertensive disorders (33.3%), Intra Uterine Growth Restriction (10.2%), Antepartum haemorrhage (25%), Preterm birth (16.3%) were more in lateral placentation. The number of central placentas having NICU admissions were 62(16.4%) and lateral placenta with NICU admissions were 19(26%).Conclusions: There is a significant association between lateral placentation and abnormal pregnancy and neonatal outcomes. Second trimester ultrasound can be used as non-invasive predictor of adverse pregnancy and neonatal outcomes.

Effect of lemongrass decoction in reduction of blood pressure among individuals with hypertension in selected community area, Kerala

INTRODUCTION: Hypertension is the silent killer disease of today. Lemon grass decoction is one of the interventions found to reduce the blood pressure for hypertension. This study aimed to evaluate the effect of lemon grass decoction on reduction of blood pressure among individuals with hypertension in selected community area, Kerala. OBJECTIVE: The main objective of the study was to assess the effectiveness of lemon grass decoction on reduction of blood pressure among individuals with hypertension in the experimental group. METHOD: The research design was true experimental pre-test and post-test control group design. Sixty individuals with hypertension were recruited by simple random sampling technique into two groups. Experimental group (n=30) received 250 ml of lemon grass decoction for one time a day for 14 days and control group (n=30) were not received intervention for 14 days. RESULT: Statistical findings revealed that the post-test mean systolic blood pressure was 129.33 in experimental group and 142.00 in control group. Thus mean systolic blood pressure of experimental group was less than control group. The obtained ‘t’ value was 3.840, significant at 0.001 level. CONCLUSION: The use of lemon grass decoction is effective in reduction of blood pressure among individuals with hypertension

Decision to delivery interval in emergency LSCS and its impact on fetal outcome

Background: Emergency LSCS can be categorized based on RCOG guidelines into category I and II which indicates maternal or fetal compromise. Here an urgent delivery and the DDI (decision to delivery interval) within 30 and 45 minutes respectively is needed.Methods: This is a retrospective cross-sectional analysis conducted on a sample of 630 patients who underwent caesarean section over a year, from June 2016 to June 2017. The DDI were further classified into ≤30 and >30 minutes for category I, ≤45 and >45 minutes for category II LSCS. The primary objective is to determine whether DDI in Category I and II emergency LSCS has an impact on fetal outcome and secondary objective is to ensure that DDI is within the standard criterion as per RCOG protocol.Results: Out of 630 samples of caesareans, it was found that 173 falls in Category I and 189 falls in Category II. Out of 87 (50.29%) patients delivered within 30 minutes in Category I, 29 babies required NICU admission. DDI was more than 30 minutes in 86 (49.71%) cases in Category I out of which 38 babies got admitted in NICU with low APGAR scores. Out of 176 (93.12%) patients who delivered within 45 minutes in Category II, 56 babies required NICU admission. DDI was more than 45 minutes in 13 (6.88%) cases in Category II and all these babies got admitted in NICU.Conclusions: Decision -delivery interval has a significant impact on fetal outcome

Clinical profile and short-term outcome of perinatally asphyxiated term neonates in a tertiary hospital in Southern Kerala

Introduction: In India, in spite of improvement in perinatal-neonatal care, perinatal asphyxia accounts for 23% of the neonatal deaths. Objective: The objective of the study was to study the clinical profile and short-term outcome of perinatally asphyxiated term neonates. Materials and Methods: This prospective study conducted at a tertiary care teaching hospital in Southern Kerala from June 2011 to June 2015. 120 term asphyxiated neonates fulfilling the inclusion criteria admitted in the NICU were followed up till death or survival. Results: 49.2% babies were inborn and 50.8% babies were outborn. Of the total, 53 (44.2%) were delivered vaginally, 54 (45%) by cesarean section, and 13 (10.8%) by instrumental delivery. Antenatal complications were seen in 58 (48.3%) and intrapartum complications in 93 (77.5%). Hypoxic ischemic encephalopathy (HIE) was diagnosed in 78.3%, with HIE 1 in 19.3%, HIE 2 in 27.5%, and HIE 3 in 31.6%. The mortality was 31 (25.8%) and it was more in out born babies compared to inborn. Factors associated with development of severe HIE (HIE 3) were male gender (p=0.0057), need for endotracheal intubation (p=0.0114), instrumental delivery and pH <7.2 (p=0.0013). Factors associated with mortality were instrumental delivery (p=0.0032), place of birth (p=0.0012), pH ≤ 7 (p=0.0006), HIE 3 (p<0.0001), and 5 min Apgar ≤3 (p=0.0372). Conclusion: HIE was seen in 78.3% perinatally asphyxiated babies with HIE 3 contributing to 31.6%. The mortality rate in HIE 3 was 81.6% which was significantly associated with place of birth, instrumental delivery, pH <7, and 5 min Apgar ≤3

Effect of nurse culture on inducing division of isolated pollen protoplasts of Hevea brasiliensis

Haploids are of great relevance in crop improvement of Hevea, a highly heterozygous tree species with a long breeding cycle. The isolation and culture of pollen protoplasts may be a viable proposition for raising haploid plants/ homozygous lines in Hevea. The present work envisages the development of a method for the isolation and culture of pollen protoplasts of Hevea. Effect of different nurse cultures on the development of cultured protoplasts has been studied. Intact pollen grains were isolated from mature male flowers of Hevea prior to opening. Viable protoplasts in high yield could be isolated from these pollen grains when exposed to a mixture of 0.5 per cent cellulase and 0.05 per cent pectolyase in the presence of the osmotic stabilizers 0.6 M mannitol and 0.3 M sorbitol. These protoplasts were partially purified and cultured in the nutrient medium with three different nurse cultures namely embryogenic calli from Hevea, tobacco and carrot. Division of the cultured protoplasts leading to the formation of a few micro-colonies was observed in the medium containing 0.8 mg l-1 2, 4-D and 0.5 mg l-1 BA and enriched with Hevea nurse culture. Cultures with micro-colonies are dark incubated for further development. This is the first report of division of pollen protoplasts and micro-colony formation in Hevea brasiliensis

Secondary postpartum hemorrhage after pineapple juice- a case report

Postpartum hemorrhage (PPH) is defined as blood loss through the genital tract, exceeding 500 mL following vaginal birth and 1000 mL following caesarean section. PPH occurring between 24 hours to 12 weeks postpartum is defined as secondary PPH. PPH is the most common preventable cause of maternal morbidity and mortality. Detailed history and careful clinical examination can help in proper diagnosis. This is a case report of consumption of pineapple juice, that caused secondary PPH. Bromelain in pineapple juice is known to have proteolytic, fibrinolytic, anti-inflammatory and antithrombotic properties. It causes moderate prolongation of activated partial thromboplastin time (APTT), thus delaying coagulation. This action of bromelain was found to be concentration dependent. Prompt activation of the transfusion protocol can be lifesaving. Coagulation parameters should be monitored and respective blood products should be given. Thromboelastogram (TEG)/ Rotational Thromboelastometry (ROTEM) can be used for the same. To conclude, a multi-disciplinary approach is ideal. Mechanical and medical management of PPH should be started simultaneously. This should be followed by surgical procedures. If interventional radiology procedures like uterine artery embolization are available, they can be utilised, without risking the life of the mother

Levonorgesterel releasing intra uterine system in the control of heavy menstrual bleeding. Is it an alternative to hysterectomy?

Background: Heavy menstrual bleeding (HMB) affects 10 to 35% of women. Studies indicate LNG-IUS which releases controlled amounts of levonorgestrel (LNG) is effective in non- surgical treatment for HMB and has fewer side effects when compared to the conventional pharmacological agents. It also improves the quality of life. Levonorgesterel releasing intra uterine system can be an alternative to hysterectomy in the control of HMB.Methods: Retrospective study of 2 years in a tertiary care centre, Kochi. 170 women with abnormal uterine bleeding were enrolled in the study. Clinical examination, routine investigations and imaging was done.  Endometrial sampling done and followed with HPE reports in indicated cases.Results: Mean age was 41 years. 30.6% had menorrhagia. Adenomyosis in 44% and endometrial hyperplasia in 19. 4%. Lost follow up in 12.9% cases and expulsion in 3.6%. 4.1% were unsatisfied and had hysterectomy. The uterine width in adenomyosis was significantly reduced p <0.012. The mean ET in endometrial hyperplasia cases also significantly reduced with p <0.01. Satisfaction rate was 97%.Conclusions: LNG-IUS is having a high success rate in controlling menstrual symptoms, thereby improving the quality of life and avoiding hysterectomy in women with abnormal uterine bleeding. It is highly efficient in symptomatic relief of adenomyosis and reduction in the uterine volume (width). Endometrial hyperplasia showed complete regression with LNG-IUS

OASIS: clinical audit in a tertiary care centre

Background: Obstetric anal sphincter injury involves injury to the anal sphincter and rectal mucosa sustained at time of vaginal delivery and can result in significant long-term morbidity. These injuries have been defined as 3rd and 4th degree lacerations that involve disruption of the anal sphincter and rectal mucosa respectively. Objectives of this study were to find out the incidence of obstetrical anal sphincter injuries, to identify the risk factors for of OASIS and the outcome of primary repair in terms of anal incontinence and its associated complications.Methods: We did a descriptive study of OASIS by retrospective analysis of the labour case records. The study period was 1 year between August 2016 to July 2017. Inclusion criteria were singleton pregnancy, vertex presentation, instrumental and normal vaginal delivery. Exclusion criteria were multiple pregnancy, non-vertex presentation and caesarean section. Proforma was developed to capture the age, parity, gestational age in weeks, induction of labour, epidural analgesia, delivery duration, type of episiotomy, instrumentation, shoulder dystocia, occipito posterior position,manual support, weight of the baby, suturing method. Postnatal evaluation after 6 weeks and 6 months for perineal discomfort, pain, incontinence, wound infection, breakdown, fistula were noted. Results: The incidence of OASIS was 1.4%. 81.8% women had 3rd degree perineal and 18.1% had 4th degree perineal tear. The mean age of the patients were 27.9 years, gestational age of 39.45 weeks, 72.7% were primiparous. Induction of labour with prostaglandins was done in 36.36% and Pitocin augmentation for 81.81%. The duration of second 36.36% had 60-89 min and 27.27% had duration more than 90 min. 54.54% had epidural analgesia, 36.36% had shoulder dystocia, 36.36% had instrumental delivery. 72.72% babies had birth weight between 3-3.5 kg, 9% between 3.5-4 kg. Ano vaginal fistula developed in 9%.Conclusions: Appropriate training, anticipating and identifying major degrees of perineal tear helps in reducing the complications. Anovaginal fistula is distressing and disabling the patient and to her near ones