Feto-maternal outcome in patients with couvelaire uterus: a 3 year study in a tertiary care hospital in rural Karnataka, India

Background: Couvelaire uterus also known as uteroplacental apoplexy is a life threatening condition where abruptio placenta causes bleeding that penetrates into the uterine myometrium. It can only be diagnosed on direct visualization. Therefore, its occurrence is perhaps under reported and underestimated in the literature. The objective of this study was to determine the risk factors for couvelaire uterus and feto-maternal outcomes associated with couvelaire uterus in comparison with patients who presented with abruption without couvelaire uterus in a tertiary care hospital in rural Karnataka.Methods: All women who had abruptio placenta who were delivered by cesarean section were included in the study. Cases were women with couvelaire uterus and controls were women without couvelaire uterus observed intraoperatively during cesarean section.Results: Patients without couvelaire uterus had significantly more vaginal bleeding (22.2% vs 75%). However, patients with couvelaire uterus had a higher incidence of PPH (66.7% vs 28.6%), need for blood transfusion (5.9±3.2 pints vs 1.6±1.8 pints), DIC (22.2% vs 14.3%), maternal mortality (5.6% vs 0) and adverse neonatal outcome.Conclusions: We conclude that patients with couvelaire uterus had an increased risk of maternal complications such as postpartum hemorrhage and disseminated intravascular coagulation which resulted in increased need for blood transfusion, prolonged hospital stay and maternal morbidity and mortality. Present study further highlights that adverse neonatal outcomes such as low birth weight, low Apgar score and neonatal death were more frequently associated with couvelaire uterus. Thus, the presence of couvelaire uterus may be considered as a severe form of abruption and such patients should be anticipated for higher incidence and risk for maternal and neonatal morbidity

Diffusion of Mobile Phones in China

Diffusion of mobile communication has induced great societal changes in China. Factors at global market, communications industry and end-user market levels are driving the adoption at a high rate. Firstly, China’s economic emergence together with e.g. accession to WTO has led to foreign investment increase in telecom and communications industry. Secondly, a parallel deregulation and reengineering of the telecom industry ensured an introduction of competition in the domestic terminals market and facilitated manufacturing in China. Finally, overall growth in China has increased purchasing power enabling consumers to adopt new technologies. At the market level, challenges and future growth depends on a favorable business environment both for local and multinationals organizations, operators and service providers, and most importantly to the distribution channels (retailers and resellers). Market mechanisms such as improvement in payment methods, regulations for content providers, branded and low-end mobile phones marketing, applications and support in Chinese language are required for a systematic and not just sporadic adoption of mobile devices. Product development and innovation, improvement in distribution infrastructure, mobile services operators skill enhancement are some measures that can growth of mobile communication and increase in average consumer spending

Puerperal sepsis: predominant organisms and their antibiotic sensitivity pattern

Background: Puerperal sepsis is among the leading cause of preventable maternal morbidity and mortality not only in developing countries but in developed countries as well. This study was undertaken to isolate and identify aerobic bacterial agents of puerperal sepsis among the patients admitted in rural medical college of Maharashtra.Methods: Blood samples were collected from 67 cases of Puerperal sepsis and were cultured aerobically. The organisms were identified by standard biochemical tests. Antimicrobial sensitivity testing done by Kirby Bauer disc diffusion method.Results: Out of 67 samples, 46 (68.65%) yielded growth in blood culture. The isolated organisms were Klebsiella aerogenes, Staph. aureus, Pseudomonas aeruginosa, Proteus, E. coli, Streptococcus pyogenes and coagulase negative Staphylococci. Most of the organisms are resistant to commonly used antibiotics such as ampicillin, penicillin and amikacin.Conclusions: Puerperal sepsis is the common life threatening condition in the postnatal period, particularly following vaginal delivery. Early diagnosis and appropriate treatment of puerperal sepsis can make the difference between life and death

Implications of photon-ALP oscillations in the extragalactic neutrino source TXS 0506+056 at sub-PeV energies

Photon-axion-like particle (ALP) oscillations result in the survival of gamma rays from distant sources above TeV energies. Studies of events observed by CAST, Fermi-LAT, and IACT have constrained the ALP parameters. We investigate the effect of photon-ALP oscillations on the gamma-ray spectra of the first extragalactic neutrino source, TXS 0506+056, for observations by Fermi-LAT and MAGIC around the IC170922-A alert. We obtain a constraint on the ALP coupling parameter $g_{a\gamma} < 5 \times 10^{-11}$ GeV$^{-1}$ with 95% C.L. when focusing on the ALP mass range 0.1 neV $\le$ $m_a$ $\le$ 1000 neV. Importantly, we study the implications of ALP-$\gamma$ oscillations on the counterpart $\gamma$ rays of the sub-PeV neutrinos observed from TXS 0506+056. We also show the diffuse $\gamma$-ray fluxes and observabilities from flat-spectrum radio quasars, high-synchrotron peaked sources, and low-intermediate-synchrotron peaked sources, assuming similar gamma-ray emissions as that from TXS 0506+056.Comment: 10 pages, 5 figures; Published versio

Prospective study of contraceptive knowledge among the patients seeking medical termination of pregnancy in 1st and 2nd trimester in a tertiary health care

Background: A rapid population growth is a burden on the resources of many developing countries. Unregulated fertility, which contributes to such situations compromise the economic development and political stability.Methods: It was a prospective, observational study over a period of 12 months at Vani Vilas hospital, attached to Bangalore Medical College and Research Institute. All patients seeking medical termination of pregnancy in I and II trimester in tertiary health care were evaluated for contraceptive knowledge.Results: Majority of the patients were from 25 – 30 years, educated, and had married life of 5 years, multipara, with no relationship with religion. The major reason for seeking termination of pregnancy was V i.e. failure of contraception. Intrauterine devices are the most popular method of contraception. There were various sources for knowledge.Conclusions: This study concludes that there is considerable level of knowledge and awareness about contraception in the above studied women but actual practice of those methods is low

Abnormal uterine bleeding in relation to thyroid dysfunction

Background: Abnormal uterine bleeding is an abnormal bleeding from the uterus in absence of any organic disease of genital tract and demonstrable extra genital causes. Thyroid dysfunction is marked by large number of menstrual abnormalities. This study is aimed at detecting thyroid dysfunction in patients with provisional diagnosis of AUB (abnormal uterine bleeding).and refer positive cases to physician for further management.Methods: All patients from are from puberty to pre-menopausal age groups, presenting as menoraghia, metrorragia, polymenorrhoea, polymenorragia, hypomenorrhoea, and acyclical bleeding. Onset, duration, amount of bleeding, complaints related to thyroid dysfunction was noted in detail. A thorough clinical examination including general physical examination, neck examination, systemic and gynecological examination was carried out, with special reference to thyroid dysfunction. A provisional clinical diagnosis of DUB was made. Patients with clinical signs and symptoms of thyroid disease were excluded. All these patients were subjected to routine investigations like Hb%, blood counts, urine routine, and bleeding and clotting time to rule out coagulation defects. Then all were subjected for serum T3, T4, and TSH estimation. Patients were then grouped into 4 categories: euthyroid, subclinical lhypothyroid, hypothyroid, and hyperthyroid. Patients who had thyroid disease, on hormonal treatment, IUCD users, and bleeding disorders were excluded.Results: Among 100 patients studied with abnormal uterine bleeding, patients were distributed according to age groups from puberty to perimenopause age. Majority of patients belongs to 31-40 years of age about 40% and the least age group were between 41-45 years of age.(7%).Among different parity status AUB was more common among para three patients(26%). Out of 100 patients, 32% of patients had thyroid dysfunction of which 16% of patients had subclinical hypothyroidism. 15% of patients had hypothyroidism and only 2% of patients had hyperthyroidism. The commonest bleeding abnormality in AUB were polymenorrhoea (30%) and menorrhagia (35%). All hyperthyroid cases were oligomenorrhoeic.Conclusions: This study concludes that thyroid dysfunction should be considered as an important etiological factor for menstrual abnormality. The biochemical evaluation of T3, T4, and TSH estimations should be made mandatory in AUB cases to detect apparent and occult thyroid dysfunction

Observational cross-sectional study to evaluate the effects of self-medication with topical agents used by patients for superficial fungal skin infection at tertiary care hospital in Mumbai

Background: Superficial fungal infections of the hair, skin, and nails are a major cause of morbidity in the world and their incidence continues to increase. While self-medication is also one of the major health concerns for health authorities worldwide. The aim of the study was to evaluate the effects of topical agents used by patients for self-medication, to enlisting the topical agents used by patients for self-medication, to ensure by whose suggestion’s patients engaged in self-medication.Methods: It was an observational cross-sectional study which was conducted at the outpatient department (OPD) of dermatology in tertiary care hospital. A detailed history of the participant was recorded regarding topical agents used for self-medication and their effects were documented in a predesigned case record form.Results: The population consisted of 128 males and 87 females. All these 215 participants had used 61 topical agents of different brand names and the majority of were irritant, corticosteroids and antifungal much high in use. Among 215 participants, 111 had temporary relief from the infection and reoccurred after stopping its use. 98 showed aggravation in their infection among which 90 showed effects like irritation, burning and itching at the application site, while 8 participants showed dryness or flaking of skin.Conclusions: Self-medication is widely practiced among patients with a superficial fungal skin infection in Mumbai. A pharmacist was the major source for obtaining these topical agents. We can conclude, there is a need to counsel and discourage patients from self-medication and regulations for dispensing the prescribed drugs should be made stringent

Linezolid susceptibility in MRSA isolates: insights into resistance and concordance in phenotypic detection methods

Background: Methicillin-resistant staphylococcus aureus (MRSA) poses persistent threat, affecting both healthcare environment and communities, with substantial impact on infection rates, morbidity, mortality, and healthcare costs. Vancomycin, a longstanding cornerstone in MRSA treatment, but with the emergence of vancomycin resistant MRSA (VRSA), necessitating alternative antimicrobial solutions. Linezolid, stands out as a promising candidate. It has unique advantages such as an absence of renal toxicity and improved lung parenchymal diffusion compared to vancomycin, making it an appealing choice, especially for healthcare-acquired pneumonia by MRSA. Methods: This cross-sectional study investigated linezolid susceptibility in 158 MRSA isolates using both disk diffusion and agar dilution method. Results: Results indicated that the majority of isolates exhibited linezolid susceptibility, with 53.16% showing a minimum inhibitory concentration (MIC) of ≤2 µg/ml. However, two MRSA isolates, constituting 1.27% of the sample, displayed a MIC of 8 µg/ml, named them as a linezolid-resistant MRSA (LRSA). These findings align with previous research, mirroring resistance rates observed in different regions. Notably, vigilance against linezolid resistance is crucial, particularly due to its status as a last-resort MRSA treatment. Conclusions: Remarkably, a 100% concordance was found between the disk diffusion and MIC methods for detecting linezolid resistance in MRSA, suggesting that the disk diffusion method may be practical choice for laboratories with heavy workloads. However, adherence to CLSI guidelines is essential, and cases of resistance by disk diffusion should be confirmed using MIC methods. Emergence of linezolid-resistant MRSA is a worrisome development, necessitating ongoing surveillance and vigilance

Kedudukan Dewan Perwakilan Rakyat Daerah (Dprd) dalam Penyelenggaraan Pemerintahan Daerah Berdasarkan Undang-undang Nomor 23 Tahun 2014

Position the House of Representatives (DPRD), which is referred to as the local legislative body by the public, it is not so. Parliament is one of the elements of the regional administration together with the Regional Head, so that Parliament is a partner of the Regional Head, located parallel to the regional head. Parliament only perform the function of legislation in the area by establishing rules and regulations along the regional level Regional Head, as the regional regulation. The purpose of this study is to determine how exactly the position of Parliament in the regional administration together with the head of the region, as well as how to do with the implementation of the concept of the Unitary Republic of Indonesia (NKRI). This study was included in the normative legal research is the study of law with a review of the legal materials in the form of legislation and study books or library materials available. While the nature of this research is descriptive research is research that provides a clear and detailed picture of the problems studied. The data used is primary data that materials are binding law, as well as secondary data derived from primary legal materials, secondary and tertiary. Data was collected by the method of literature review. The result of this study is that the position of the Council is a partner in running the Regional Head of the regional administration. Indeed, the legislative power is in the realm of the center instead of on the local level, in Parliament ought to be regular penenrapannya position themselves as partners in helping both the Regional Heads in making regulations or the regional administration. Efforts are expected in order to Act No. 23 of 2014 may be revised or amended by the Act which tebaru, so that the absence of any reinterpretation of the Local Government Act

Retain womb in retained placenta: hysterotomy for retained bilobed placenta in a preterm angular pregnancy

Angular pregnancy is a unique condition, which may be associated with both foetal and placental abnormalities, as well as preterm labour and retained placenta. Ultrasound is a useful tool in deciding feasibility of manual removal placenta by ruling out adherent placenta. A twenty five years primipara, five hours following preterm vaginal delivery, at 31 weeks of gestation presented with retained placenta. Uterus was well retracted with minimal bleeding, on trans-abdominal ultrasonography placenta accreta was ruled out. After stabilising, she had hysterotomy and placenta was removed which was bilobed. Neonate had cardiac and renal anomaly and succumbed at the end of one month of life. In young women prime priority is to preserve the uterus, by conservative approach as in our case