Analytical study to assess fetal and perinatal outcome in booked and unbooked obstetric cases

Background: The high perinatal mortality rates are indicators of the poor state of health services and it is pertinent to determine the relationship between the booking status of mother and fetal outcomes.Methods: In the present randomized prospective study of 400 unbooked (study group) obstetric cases were evaluated and compared with 400 booked (control group) obstetric cases over a period of one year.Results: Perinatal outcomes of women in study group were significantly poorer than women in control group due to high preterm delivery, LBW, with low Apgar score at five minutes, with more NICU admission due to RDS, with high perinatal mortality in term of IUD, early neonatal deaths in study group.Conclusions: Findings of the study will help the programmers and service providers in identifying areas where emphasis has to be given in the development of strategies that will promote the utilization of antenatal services, to reduce adverse perinatal and fetal outcome

Patient Diagnosis System Using Evolutionary Computation

Hospital management and business processes in hospitals have changed importantly over the past twenty years, as did the use of hospital information systems. In order to manage, search, and display patient information more efficiently, we define a patient information package . It is a set of a patients medical information from each visit. By means of patient information package s , both patient - oriented and problem - oriented query strategies, which are most frequently used in daily clinical practice and medical education, can be accommodated. As the symptoms of the patients were entered into the system and the system will run diagnosis system and gives result about the diseases he is suffering from. It also suggests the medicine for the particular di sease from which the patient is suffering to doctor

Suprasellar epidermoid cyst: a rare cause of painless progressive bilateral vision loss-case report with clinico-radiological correlation

Intracranial epidermoid cysts are relatively rare lesions. They result from inclusion of ectodermal elements during time of neural tube closure. This lesion could rarely be acquired due to post-surgical or post traumatic implantation of the ectodermal components. They typically present in middle age group patients with evidence of loco-regional mass effect on adjacent structures. We present a clinico-radiological case report of the 27-year-old female patient who presented with painless progressive bilateral vision loss for last 4 months

Impact of COVID 19 in antenatal patient with gestational diabetes mellitus and vice a versa: a retrospective study

Background: The objective of this study is to compare the incidence, severity and feto-maternal outcome of antenatal Coronavirus disease 2019 (COVID-19) positive patients with GDM vs non GDM patients.Methods: This is a retrospective observational study. The study was carried out in department of Obstetrics and Gynecology, GSVM Medical College, Kanpur from March 2020 to December 2020. All the antenatal women with COVID 19 positive status who were admitted during this period were enrolled in the study. Analysis were made on the basis of observation regarding the severity of symptoms COVID 19 disease, oxygen requirements, mode of delivery and neonatal outcome in GDM vs non GDM COVID positive antenatal patient.Results: A total of 421 COVID positive antenatal patients were enrolled of which 21 patients were having GDM and 400 were non GDM. Of these 21 patients, 14 (66.7%) were diagnosed with GDM after admission while 7 patients i.e., 33.3% were already diagnosed GDM before admission in current pregnancy. Of these 21 (42.9%) antenatal COVID pt with GDM majority shows mild symptoms of COVID 19, however the severity of fever, myalgia and cough was increased in GDM compared to Non GDM Group. While in non GDM Group, majority of patients were asymptomatic (44.3%) and severity was also less.Conclusions: It is also evident that patients with GDM had longer duration of hospital stay, higher incidence of caesarean delivery and oxygen requirements

A clinical study on maternal and fetal outcome in pregnancy with oligohydromnios

Background: Oligohydramnios is associated with various maternal and fetal complication. It’s correlated fetal complications like FGR, increased risk of meconium aspiration syndrome, Birth asphyxia, low APGAR scores and increased congenital abnormalities in fetus. It’s also associated with maternal morbidities in view of operative interventions for delivery. To study effect of oligohydramnios in mother in form of, operative delivery and progress of labour. To study effect of oligohydramnios in fetus in form of fetal compromise i.e.  FGR, fetal distress, altered APGAR score, need for NICU admission. congenital anomaly and perinatal death.Methods: 50 patients with ≥ 28 weeks POG with oligohydramnios, confirmed by ultrasonographic measurement of AFI using four quadrant technique; were selected randomly after fulfilling inclusion and exclusion criteria.Results: Incidence of oligohydramnios were more found in primigravida (56%) in present study. Most common cause of oligohydramnios was idiopathic (62%) followed by PIH (20%). Most common cause of caesarean was fetal distress (23%) either due to cord compression or FGR. oligohydramnios was related to higher rate of Fetal Growth restriction and NICU admission (24%).Conclusions: Oligohydramnios is very common encounter during pregnancy, Because of its frequent occurrence; it demands intensive fetal monitoring and systemic approach to antepartum and intrapartum fetal surveillance. There is increased risk of intrapartum complication, perinatal morbidity, perinatal mortality; thus, the rate of caesarean increasing day by day.one should always know the fine line between vaginal delivery and caesarean section; move ahead with best option without hampering fetal wellbeing and avoid unnecessary operative morbidity

Curious case of corpus callosal hematoma in a normotensive post-partum female patient: a case report of reversible post-partum angiopathy with clinico-radiological correlation

Postpartum cerebral angiopathy (PCA) is a rare cause of stroke in the puerperium. It usually presents with episodes of headache, seizures and neurological deficits in early post-partum period in normotensive females. CT, MRI and catheter angiography may demonstrate segmental vasoconstriction that often resolves spontaneously. PPA is generally regarded as a benign, non-relapsing and reversible disease process. We present a clinico-radiological correlative case of isolated corpus callosal hematoma in a post-partum normotensive female with evidence of intracranial vascular spasm and luminal irregularity on CT and catheter angiography. Follow up MR angiography showed resolution of the vasospasm and luminal irregularity. Patient was managed conservatively and showed resolution of the symptoms in follow up visit on 8th week.

A study to assess the effectiveness of clinical teaching on the level of knowledge regarding nursing care bundle to prevent ventilator associated pneumonia among ICU nursing officers at AIIMS Bhopal

Background: Healthcare is a professional area bound to the ethical foundation of “do no harm.”, But in the current scenario, a rush to promote the curative scenario has led to the total downplay of the preventive aspect of care. The aim of this study was to assess the knowledge regarding nursing care bundle for the prevention of VAP among nursing officers before and after clinical teaching and to evaluate the effectiveness of clinical teaching. Methods: This pretest-post-test study was conducted on nursing officers working in the ICU of the All-India Institute of Medical Sciences, Bhopal, Madhya Pradesh. 100 nursing officers were enrolled in the study via convenience sampling technique. The self-structured tool was validated by 10 experts with a mean CVI value of 0.94. The reliability of the self-structured knowledge questionnaire was determined by the test-retest method and found to be 0.87. The collected data was analysed for frequency, mean, standard deviation, t-test, and association. Results: Findings showed that the mean knowledge score was 18.46±3.543 before intervention. After the intervention of video-assisted clinical teaching, a post-test was conducted, and the mean post-test knowledge scores was 25.07±2.801 at the p value <0.01. Knowledge of subjects about nursing care bundle for prevention of VAP was found to have a significant association with only educational qualification. Conclusions: This study's findings concluded that educational interventions are necessary for the enhancement of knowledge and better compliance of nursing officers with guidelines regarding the bundle of care for the prevention of ventilator-associated pneumonia

Canonical Wnts function as potent regulators of osteogenesis by human mesenchymal stem cells

Genetic evidence indicates that Wnt signaling is critically involved in bone homeostasis. In this study, we investigated the functions of canonical Wnts on differentiation of adult multipotent human mesenchymal stem cells (hMSCs) in vitro and in vivo. We observe differential sensitivities of hMSCs to Wnt inhibition of osteogenesis versus adipogenesis, which favors osteoblastic commitment under binary in vitro differentiation conditions. Wnt inhibition of osteogenesis is associated with decreased expression of osteoblastic transcription factors and inhibition of c-Jun N-terminal kinase and p38 mitogen-activated protein kinase activation, which are involved in osteogenic differentiation. An hMSC subpopulation exhibits high endogenous Wnt signaling, the inhibition of which enhances osteogenic and adipogenic differentiation in vitro. In an in vivo bone formation model, high levels of Wnt signaling inhibit de novo bone formation by hMSCs. However, hMSCs with exogenous expression of Wnt1 but not stabilized β-catenin markedly stimulate bone formation by naive hMSCs, arguing for an important role of a canonical Wnt gradient in hMSC osteogenesis in vivo

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH