Comparative study of nifepidine and isoxsuprine in suppression of preterm labour

Background: A prospective study was conducted to compare the efficacy of nifedipine against isoxsuprine in preventing preterm labour and also to evaluate maternal side effects and neonatal outcome.Methods: This was a randomized prospective comparative study done at MGM hospital and research center, Patna, Bihar between 15/03/2014 to 15/02/2016. 75 antenatal women with gestational age between 28 to 36 weeks were selected who fulfilled the inclusion criteria for the study, were given nifedipine and were monitored throughout the course of treatment.Results: Groups were compared with mean prolongation of delivery, side effects, neonatal outcome, parity, cervical effacements. Nifedipine was twice more effective than isoxsuprine hydrochloride as a uterine tocolytic agent while side effects were comparable with fewer side effects in nifedipine group. Neonatal outcome was better with nifedipine in comparison to isoxsuprine.Conclusions: There is a high incidence of preterm labour in India. The present study found that nifedipine has better tocolytic efficacy, less side effects and better tolerability as compared to isoxsuprine.

Gynecological problems of adolescent girls attending to rural tertiary care centre

Background: Adolescence is a transient and dynamic period between childhood and adulthood, characterised by several changes in the body and the child’s mind. The World Health Organization defines adolescents as young people aged 10-19 years, but changes may begin before and continue after this age group. Adolescents constitute over 21.4% of population in India. Adolescence is a period of enormous physical and psychological change for young girls. Hormonal events play a key role in this transition. One of the major physiological changes that take place in adolescent girls is the onset of menarche, which is often associated with problems of irregular menstruation, excessive bleeding and dysmenorrhea. The aim of this study was to determine the proportion of various gynecological problems among adolescent girls seeking care at a tertiary care centre, Kolar, Karnataka, India.Methods: A cross sectional study was conducted during March 2016 to March 2018 among all adolescent girls (10-19 years) with gynecological problems attending inpatient and outpatient Department of Obstetrics and Gynecology. A pre-tested semi-structured questionnaire was used to collect information regarding their socio-demographic characteristics, gynecological history, family history, obstetric history, documentation of general physical examination and other investigations. Data entered using Microsoft Excel and analysed using SPSS v20.Results: A total of 720 adolescent girls sought care for gynecological problems in the study period with more than 80% of the cases belonging to the age group between 15 and 19 years. Of the 720, 362 (49.8%) had some type of menstrual disorders. Of these 362 cases about 41 of them were a case of puberty menorrhagia (11.32%) and 89 cases were of dysmenorrhea (22.37%). Among 720 cases, 290 (40.2%) of them were diagnosed of teenage pregnancy; among which 34 of them were unwanted pregnancy. Other presentations include vaginal discharge, urinary tract infection, mass per abdomen, trauma to genital tract and turners syndrome (two cases).Conclusions: The study shows around half of the adolescent girls are having menstrual disorders. One third were teenage pregnancies with most of them been ‘wanted’. This alarming finding calls for strengthening of adolescent programme with targeted health education and behavioural change. Setting up a separate adolescent clinics is necessary for efficient management of menstrual disorders in adolescents

Successful maternal and fetal outcome of pregnancy following heart valve replacement using a sequential anti coagulation regime

Background: Patients with mechanical heart valves require anticoagulation which is associated with significant maternal mortality (1-4%) and fetal complications (31%) in pregnancy.  Methods: A prospective study was carried out enrolling  pregnant patients with mechanical heart valves who were booked at our institution for antenatal care, managed using a sequential  anticoagulant regime consisting of warfarin and low molecular weight heparin and delivered at our utility over two years.Results: We had seven cases of pregnancy following heart valve replacement over a period of two years with no fetal malformations and successful maternal outcome (71.43% term deliveries).Conclusions: LMWH until 13th week of gestation, followed by warfarin until late third trimester (36 weeks), then restarting LMWH until delivery in pregnant patients with mechanical heart valves was associated with successful maternal and fetal outcome.

MENTAL HEALTH AND QUALITY OF LIFE DURING COVID-19 PANDEMIC IN INDIAN POPULATION

Objective: As there is a dearth of researches targeting the Indian population on this issue, we decided to conduct a survey to assess the psychological impact of COVID-19 on mental health and quality of life of Indians. Methods: In this Cross-Sectional study, a total of 2245 participants above 16 y of age were included. Mental health variables were assessed via depression, anxiety and stress subscale (DASS-21), Insomnia Severity Index (ISI-7), Patient health questionnaire (PHQ-15), Quality of life (QoL-5) and social media exposure. Results: The multivariate logistic regression demonstrated female (OR-1.17, 95% CI: 0.99 to 1.38) had significantly higher depression scores whereas, housewife had higher depression (OR-1.68, 95% CI: 1.33 to 2.13), anxiety (OR-1.64, 95% CI: 1.15 to 2.35), insomnia (OR-1.32, 95% CI: 1.14 to 1.53), somatic symptoms (OR-1.76, 95% CI: 1.21 to 2.57). Front line workers had a higher psychological impact with increased scores of anxieties (OR-1.23, 95% CI: 0.79 to 1.53), stress (OR-1.82, 95% CI: 0.76 to 2.55), insomnia (OR-1.65, 95% CI: 1.31 to 2.09). Lower education level had significantly higher score in depression (OR-1.14, 95% CI: 0.73 to 1.32), insomnia (OR-2.42, 95% CI: 2.07 to 2.84), somatic symptoms (OR-2.59, 95% CI: 1.80 to 3.37). Poor physical health, social media exposure was significantly associated with heightened anxiety score. Conclusion: There is a need for psychological intervention as the dynamics and severity of COVID-19 is rapidly changing. These findings could guide the public health authorities to target and implement health measures to combat the pandemic

ASSESSMENT OF DENTAL FLUOROSIS IN CHILDREN OF JAIPUR DISTRICT, RAJASTHAN, INDIA

Objective: The objective of the present study was carried out to explore the potential association between fluoride concentration in drinking water and severity of dental fluorosis (DF) in the children.Methods: The study of dental fluorosis (DF) in the children (6-14 years old) was conducted in the two blocks (a) Jamwaramgarh block ;Heerawala, Palera ,Nayabas, Saipur and Birasana, (b) Amber block; Jugalpura, Chitanukalan, Sunder ka bas, Peelwa and Sirsali of Jaipur district, Rajasthan, India of the study villages. Total 150, children were surveyed. The role of fluoride (F) levels in drinking water in the etiology of dental fluorosis (DF) and the cases of dental fluorosis (DF) in both dentitions and teeth were also assessed using DEAN'S classification. The fluoride (F) concentration in source of drinking water was estimated by fluoride (F) ion specific electrode (Thermo Scientific Orion Star A329, USA).Results: The F concentration in (Tube well and Hand pump) water ranges from 0.7 to 15.0 parts per million (ppm) in Jamwaramgarh block and 1.40 to 5. 10 parts per million (ppm) in Amber block. Prevalence of dental fluorosis (DF) 27 (36%) in Jamwaramgar block and 26 (34.66%) in Amber block out of 75 children were examined in each block. Significantly increase in levels of F in drinking water is positively correlated with dental fluorosis.Conclusion: This study finding has shown the relation of dental fluorosis (DF) to high fluoride (F) levels in drinking water sources. A higher fluoride (F) levels in source of drinking water is a major risk factor for dental fluorosis. In view of the severity of the problem the intake of calcium rich foods and defluoridation techniques may help reducing risk of dental fluorosis (DF) in the children.Â

EVALUATION OF NEUROLOGICAL MANIFESTATIONS IN HUMAN IMMUNODEFICIENCY VIRUS-AIDS PATIENTS ADMITTED TO SOUTH INDIAN TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY

Objective: The objective of the study was to describe, evaluate, and analyze neurological manifestation in human immunodeficiency virus HIV positive patients admitted to a tertiary care center. Methods: The study was a prospective cross-sectional study, in which 103 HIV patients were analyzed. All patients were interviewed face to face and evaluated by the investigator with particular reference to neurological manifestations. They were classified into various stages of HIV using the World Health Organization staging system. Results: The mean age in males was 37 (standard deviation [SD] 8.0) years and in females 35 (SD 7.0) years. A greater proportion of females were diagnosed in the asymptomatic state during screening, either during pregnancy or when the spouse was found to be positive. Headache was the most common neurologic symptom and fundus abnormalities were the most common neurological sign documented in patients. The mean CD4 counts in males are 156.5/mm3 and in females are 229.57/mm3 whereas the mean absolute leukocyte count in males is 1088.30/mm3 and in females is 1473.52/mm3. The CD4 counts showed a better correlation with the occurrence of neurological manifestations than absolute leukocyte count. Conclusion: Headache was a significant predictor of the occurrence of neurological complications (p=0.01). CD4 counts were significantly lower in patients with neurological complications and most of the neurological manifestations; on the contrary, all the opportunistic infections were documented in patients with CD4 counts below 200/mm3. Neurological complications did not show any correlation with the patient being on anti-retroviral therapy

TLR4 is one of the receptors for Chikungunya virus envelope protein E2 and regulates virus induced pro-inflammatory responses in host macrophages

Toll like receptor 4 (TLR4), a pathogen-associated molecular pattern (PAMP) receptor, is known to exert inflammation in various cases of microbial infection, cancer and autoimmune disorders. However, any such involvement of TLR4 in Chikungunya virus (CHIKV) infection is yet to be explored. Accordingly, the role of TLR4 was investigated towards CHIKV infection and modulation of host immune responses in the current study using mice macrophage cell line RAW264.7, primary macrophage cells of different origins and in vivo mice model. The findings suggest that TLR4 inhibition using TAK-242 (a specific pharmacological inhibitor) reduces viral copy number as well as reduces the CHIKV-E2 protein level significantly using p38 and JNK-MAPK pathways. Moreover, this led to reduced expression of macrophage activation markers like CD14, CD86, MHC-II and pro-inflammatory cytokines (TNF, IL-6, MCP-1) significantly in both the mouse primary macrophages and RAW264.7 cell line, in vitro. Additionally, TAK-242-directed TLR4 inhibition demonstrated a significant reduction of percent E2-positive cells, viral titre and TNF expression in hPBMC-derived macrophages, in vitro. These observations were further validated in TLR4-knockout (KO) RAW cells. Furthermore, the interaction between CHIKV-E2 and TLR4 was demonstrated by immuno-precipitation studies, in vitro and supported by molecular docking analysis, in silico. TLR4-dependent viral entry was further validated by an anti-TLR4 antibody-mediated blocking experiment. It was noticed that TLR4 is necessary for the early events of viral infection, especially during the attachment and entry stages. Interestingly, it was also observed that TLR4 is not involved in the post-entry stages of CHIKV infection in host macrophages. The administration of TAK-242 decreased CHIKV infection significantly by reducing disease manifestations, improving survivability (around 75%) and reducing inflammation in mice model. Collectively, for the first time, this study reports TLR4 as one of the novel receptors to facilitate the attachment and entry of CHIKV in host macrophages, the TLR4-CHIKV-E2 interactions are essential for efficient viral entry and modulation of infection-induced pro-inflammatory responses in host macrophages, which might have translational implication for designing future therapeutics to regulate the CHIKV infection

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass